Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country.

BACKGROUND: Nosocomial Infections (NI) are a frequent and relevant problem. The purpose of this study was to determine the epidemiology of the three most common NI in a Pediatric Intensive Care Unit from a developing country. METHODS: We performed a prospective study in a single Pediatric Intensive Care Unit during 12 months. Children were assessed for 3 NI: bloodstream infections (BSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI), according to Center for Disease Control criteria. Use of devices (endotracheal tube [ETT], central venous catheter [CVC] and urinary catheter [UC]) was recorded. RESULTS: Four hundred fourteen patients were admitted; 81 patients (19.5%) developed 85 NIs. Density of incidence of BSI, VAP and UTI was 18.1, 7.9 and 5.1/1000 days of use of CVC, ETT and UC respectively. BSI was more common in children with CVCs than in those without CVCs (20% vs. 4.7%, p < 0.05). Candida spp. was the commonest microorganism in BSI (41%), followed by Coagulase-negative Staphylococcus (17%). Pseudomonas (52%) was the most common germ for VAP and Candida (71%) for UTI. The presence of NI was associated with increased mortality (38.2% vs. 20.4% in children without NI; p < 0.001) and the median length of ICU stay (23 vs. 6 days in children without NI; p < 0.001). Children with NI had longer average hospital stay previous to diagnosis of this condition (12.3 vs. 6 days; p < 0.001). CONCLUSIONS: One of every 5 children acquires an NI in the PICU. Its presence was associated with increased mortality and length of stay. At the same time a longer stay was associated with an increased risk of developing NI.

Demanda hospitalaria pediátrica en tiempos de COVID-19 / Pediatric hospital demand in the COVID-19 pandemic

RESUMEN La pandemia del COVID-19 en el Perú está causando una presión inusual a nuestros recursos hospitalarios y de cuidados críticos. A medida que la infección progresa en la población, esperamos ver un alza en los casos severos y en la demanda de unidad de cuidados intensivos (UCI) donde la capacidad de camas puede ser excedida. A pesar de que usualmente el COVID-19 causa una enfermedad poco grave en los niños, debemos estar preparados para que el numero de casos pediátricos ocasionen una sobrecarga en la capacidad de recursos hospitalarios. En un escenario de un 25% de proporción de infección acumulada en la población, podremos ver aproximadamente 891 niños críticamente enfermos que requieren hospitalización en UCI. Proponemos algunas estrategias para enfrentar la escasez de recursos de cuidados intensivos que permitan asegurar la atención de niños vulnerables con condiciones agudas y condiciones complejas que siguen incidiendo en los tiempos de pandemia.

ABSTRACT The COVID-19 pandemic in Perú is causing an unusual pressure in our sanitarian and critic care resources. As the pandemics have progressed in the population, an increasing of several cases and intensive care units (ICU) demand will be expected, because of that, the hospitals capacities would be exceeded in a short place. Despite the low severity of COVID-19 cases in children, we expect that the projected number of pediatric cases could overwhelm the available pediatric capacity. Under a 25% cumulative infection rate scenario, there would be approximately 891 critically ill children requiring ICU admission. We propose several strategies to handle the concerns about shortfalls in our ability to provide pediatric ventilation and critical care support during the epidemic in Perú.

Multiple organ dysfunction syndrome in children.

OBJECTIVE: Delineation of multiple organ dysfunction syndrome (MODS) is important because of its frequent occurrence in the pediatric intensive care unit and its association with high mortality. However, studies in children are scarce, all have been done in developed countries, and, unlike adult studies, some showed that sepsis is not related to mortality. The aim of this study was to learn about the epidemiology of MODS in our pediatric intensive care unit and to observe if sepsis is associated with mortality. DESIGN: Prospective, observational study. SETTING: A 16-bed pediatric intensive care unit. PATIENTS: A total of 269 patients admitted to the pediatric intensive care unit during the study period from August 1996 to January 1997. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 276 admissions (269 patients) during the study period. A total of 156 of them (56.5%) had MODS at some time during their pediatric intensive care unit stay, and 132 (84.6%) of the children had it at the time of admission. There were 71 deaths during the study period, and 65 of them (91.5%) had MODS. The organs less frequently involved were gastrointestinal and hepatic. In children with MODS, 87 had sepsis, and mortality in this group (51.7%) was greater than in those who did not present with sepsis (28.9%, p < .001). A Pediatric Risk of Mortality score of > or =15 and the presence of sepsis were associated with an increase in mortality risk (odds ratio, 2.8; 95% confidence interval, 1.36-5.75; and odds ratio, 2.33; 95% confidence interval, 1.18-4.59; respectively). CONCLUSIONS: MODS in children usually occurs early, and sepsis increases mortality. Hepatic and gastrointestinal failures are infrequent, and as has been suggested, they could be excluded from the majority of MODS diagnoses.

Pediatric hospital demand in COVID-19 times in Perú / Demanda hospitalaria pediátrica en tiempos de COVID-19 en Perú

COVID-19 pandemic in Perú is causing strain on critical care and hospital resources across the nation. As the infection progress into the population we expect a surge in severe cases and on the intensive care unit (ICU) demand. As the peak of the COVID-19 outbreak approaches, the capacity for hospital and ICU beds will probably be exceeded. Despite the low severity of COVID-19 in children, we expect that the projected number of pediatric cases could overwhelm the available pediatric capacity as the outbreak progress in our country. Under a 25% cumulative infection rate scenario, there would be approximately 891 critically ill children requiring ICU admission. We propose several strategies to handle the concerns about shortfalls in our ability to provide pediatric ventilation and critical care support during the epidemic in Perú.

La pandemia del COVID-19 en el Perú está causando una presión inusual a nuestros recursos hospitalarios y de cuidados críticos. A medida que la infección progresa en la población, esperamos ver un alza en los casos severos y en la demanda de unidad de cuidados intensivos (UCI) donde la capacidad de camas puede ser excedida. A pesar de que usualmente el COVID-19 causa una enfermedad poco grave en los niños, debemos estar preparados para que el numero de casos pediátricos ocasionen una sobrecarga en la capacidad de recursos hospitalarios. En un escenario de un 25% de proporción de infección acumulada en la población, podremos ver aproximadamente 891 niños críticamente enfermos que requieren hospitalización en UCI. Proponemos algunas estrategias para enfrentar la escasez de recursos de cuidados intensivos que permitan asegurar la atención de niños vulnerables con condiciones agudas y condiciones complejas que siguen incidiendo en los tiempos de pandemia.