Hospital-acquired Klebsiella pneumoniae infections in a paediatric intensive care unit

Abstract

Background. Hospital-acquired infections (HAI) are a significant problem in the delivery of intensive care services. Each nosocomial infection prolongs an affected patient’s stay in hospital by 5 - 10 days.
Methods. A retrospective case control chart review of children admitted to the paediatric intensive care unit (PICU) in Grey’s Hospital between July 2003 and December 2010, who developed a hospital-acquired Klebsiella pneumoniae infection, was undertaken to describe the trend in HAI in a newly commissioned PICU and to identify any association with the patient demographics and modalities of care. Patients with a K. pneumoniae infection were identified through the PICU infection control surveillance system. Each case was matched to a control of the same age admitted during the same period, with a similar clinical diagnosis.
Results. During the 7.5-year period, 2 266 children <12 years of age were admitted to the PICU. Of these, 113 had K. pneumoniae cultured from a body fluid >48 h after admission, including 23 cultured from the blood. Clinical records were obtained for 14 of these patients and matched to control cases of similar age and gender who were admitted at the same time. The length of stay in both the PICU and hospital was longer in children with an HAI compared with the control group (3.7 v. 2.9 and 18.5 v. 9.14, respectively; p=0.04). There was no  significant difference in the treatment modalities provided to the two groups, although most patients in the sample group required invasive treatment.
Conclusion. K. pneumoniae nosocomial infection was a significant problem encountered in Grey’s Hospital paediatric intensive care. It has major cost implications, as it prolongs the length of stay in intensive care and hospital.