Establishing Nationally Representative Central Line-Associated Bloodstream Infection (CLABSI) Surveillance Data in Paediatric Patients in Greece.

2019

53-59

2019 Jan

1532-2939

<p><strong>BACKGROUND: </strong>Healthcare-associated infections (HAIs) are associated with increased morbidity and mortality and with excess costs. Central line-associated bloodstream infections (CLABSI) are the most common HAI in neonates and children.</p>

<p><strong>AIM: </strong>The broad objective of this study was to establish national benchmark data around rates of CLABSI in neonatal and paediatric intensive care units (NICUs and PICUs) and paediatric oncology units (ONCs).</p>

<p><strong>METHODS: </strong>Active surveillance for CLABSI was conducted from June 2016 to February 2017. A collaborative of 14 NICUs, 4 PICUs, and 6 ONCs participated in the program. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event, and CLABSI rate were based on the Centers for Disease Control and Prevention's 2014 National Healthcare Safety Network criteria. Medical records were assessed daily for calculating CL days, patient days, and susceptibility of isolated organisms.</p>

<p><strong>FINDINGS: </strong>A total of 111 CLABSI episodes were recorded. The overall mean CLABSI rate was 4.41 infections per 1000 CL days, and the CLU ratio was 0.31. CLABSI rates were 6.02 in NICUs, 6.09 in PICUs, and 2.78 per 1000 CL days in ONCs. A total of 123 pathogens were isolated. The most common pathogens were Enterobacteriaceae (36%), followed by Gram-positive cocci (29%), non-fermenting Gram-negative bacteria (16%), and fungi (16%). Overall, 37% of Gram-negative pathogens were resistant to third-generation cephalosporins and 37% to carbapenems.</p>

<p><strong>CONCLUSION: </strong>Nationally representative CLABSI rates were determined for paediatric patients. These data could be used to benchmark and serve as baseline data for the design and evaluation of infection control and antimicrobial stewardship interventions.</p>

10.1016/j.jhin.2018.07.032

J. Hosp. Infect.

30059747

Variation in paediatric hospital antibiotic guidelines in Europe.

2016

72-6

2016 Jan

1468-2044

<p><strong>OBJECTIVE: </strong>To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.</p>

<p><strong>DESIGN: </strong>Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.</p>

<p><strong>RESULTS: </strong>84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.</p>

<p><strong>CONCLUSIONS: </strong>Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.</p>

10.1136/archdischild-2015-308255

Arch. Dis. Child.

26416900

Trends in the epidemiology of childhood tuberculosis in Greece.

2012

749-55

2012 Jun

1815-7920

<p><strong>SETTING: </strong>A hospital referral center for childhood tuberculosis (TB).</p>

<p><strong>OBJECTIVE: </strong>To evaluate the epidemiological and clinical features of childhood TB in the Greater Athens area in the last decade.</p>

<p><strong>DESIGN: </strong>We retrospectively reviewed the medical records of patients aged &lt;14 years treated for active TB between January 2000 and December 2009 at our pediatric TB clinic and compared the results with the patient turnover during the previous decade (1990-1999). Data concerning demographic and clinical characteristics were analyzed.</p>

<p><strong>RESULTS: </strong>A total of 321 children (median age 5.57 years, 157 males) with active TB were identified. About one third originated from areas where TB was previously recognized to be highly endemic. Twenty-three children (7%) had extra-pulmonary TB, and 61% of them originated from TB-endemic areas. Bacteriological confirmation was obtained in 40% of patients from whom specimens were obtained: 1 of 26 (3.8%) strains was multidrug-resistant. Most cases with drug-resistant Mycobacterium tuberculosis were noted among immigrant children. The average annual TB incidence was estimated at 5.37 per 100 000 for children aged &lt;14 years in the Greater Athens area. Time trend analysis for the 20-year period revealed a significant reduction in the total number of TB cases (P = 0.002) and in TB among children from low-incidence countries (P &lt; 0.0001).</p>

<p><strong>CONCLUSIONS: </strong>In our settings, active TB is decreasing among children of Greek origin; disease epidemiology and drug resistance is influenced by the increasing influx of immigrants from areas where the disease is highly prevalent.</p>

10.5588/ijtld.10.0717

Int. J. Tuberc. Lung Dis.

22507870

Colonization of high-risk children with carbapenemase-producing Enterobacteriaceae in Greece.

2013

757-9

2013 Jul

1559-6834

10.1086/670997

Infect Control Hosp Epidemiol

23739084