Prevalence and contributing factors of nosocomial bloodstream infections in pediatric cardiac ICU patients at chamran hospital, Isfahan

Abstract

BACKGROUND: Congenital heart disease (CHD) profoundly impacts pediatric health, leading to increased morbidity and complex care requirements, often resulting in prolonged hospital stays. Nosocomial infections, particularly bloodstream infections (BSIs), pose a significant risk in the Pediatric Cardiac Intensive Care Unit (PCICU). This study aims to evaluate the prevalence of nosocomial BSIs in children with CHD within the PCICU and to identify associated risk factors. METHODS: A retrospective analysis was conducted on data recorded from patients under 18 years of age who had confirmed positive blood cultures and were hospitalized for a minimum of 48 hours from March 2019 to March 2022. Demographic, clinical, and microbiological information was collected, and statistical analyses were performed to determine the relationships between various risk factors and positive blood cultures. RESULTS: In this analysis of 510 patients evaluated, positive blood cultures were found in 16.7 of patients. Patients with positive cultures were significantly younger and had lower mean weights (P<0.05). Recovery status was a significant predictor of blood culture results (p<0.001). Device utilization, including urinary catheters and central venous lines, was notably higher in the positive culture group (P<0.05). Additionally, a higher proportion of patients with positive cultures had acyanotic CHD, with significant associations for Patent Ductus Arteriosus (PDA), Ventricular Septal Defect (VSD), and Atrial Septal Defect (ASD) (P<0.001). Improved recovery status decreased the likelihood of positive blood cultures by approximately 52.2 (odds ratio 0.478, p=0.0021). CONCLUSION: Our findings reveal a high prevalence of BSIs in the PCICU, highlighting some associated risk factors such as recovery status, use of central vein catheters, dialysis and Foley catheters, younger age, and lower weight. This study emphasizes the necessity for rigorous infection control measures, particularly regarding the management of invasive devices and prompt clinical interventions, to improve patient outcomes in this high-risk population. Enhanced surveillance and tailored guidelines are essential for reducing the risks of nosocomial infections in pediatric cardiac care settings.