Study to compile data on pediatric infection

A landmark prevalence study of nosocomial infections and antibiotic-resistant organisms in pediatric hospitals is slated to begin this year as part of a project by the Centers for Disease Control and Prevention and the National Association of Children’s Hospitals and Related Institutions (NACHRI) in Alexandria, VA. According to NACHRI project plans, the research will include the following aspects:

Prevalence and impact of pediatric nosocomial infections: The impact of nosocomial infections, as measured by prolonged hospitalization, increased morbidity and mortality, and cost to the patient and health care system is tremendous. However, all national estimates of the prevalence or incidence of nosocomial infections in the United States have thus far been conducted in adult populations. No national estimates of the prevalence or incidence of nosocomial infections have been made in pediatric populations at U.S. children’s hospitals. Objectives of the study are to estimate the prevalence of nosocomial infections in pediatric patients at U.S. children’s hospitals and to estimate the impact of these nosocomial infections by measuring extended hospital stay and costs.

All NACHRI participants will conduct a prevalence survey of all nosocomial infections occurring in their facilities by collecting the number of infections and number of patient-days by service over one week (e.g., pediatric intensive care unit [ICU] on day one, neonatal ICU on day two, selected wards on days three through five). For each patient with a nosocomial infection, selected data, including antimicrobial exposure and antimicrobial resistance of the nosocomial pathogen, will be collected. In addition, a random sample of pediatric patients with a nosocomial infection and comparison patients without nosocomial infections will be selected. The length of hospital stay, costs, charges, and reimbursement received will be determined for these patients.

Antimicrobial use and resistance: As resistant bacteria spread, many common infectious diseases are becoming more difficult and expensive to treat. Recently, as lower-birth-weight neonates remain in the neonatal intensive care unit (NICU) longer, nosocomial infections in this population caused by antimicrobial-resistant bacteria are becoming more prevalent.

All participating children’s hospitals will collect: demographic data (e.g., patient-days, total number of patients); specific data for selected antimicrobial-bacteria combinations (e.g., Staphylococcus aureus and methicillin; enterococci and vancomycin); and pharmacy data on the quantity of selected parenteral and oral antimicrobials used. Since antimicrobials are dosed by infant weight, total doses given per month of each antimicrobial administered should be reported rather than collecting total grams of antibiotics used. These data can be used to assess the relationship between antimicrobial use and the prevalence or emergence of antimicrobial resistance. In addition, the prevalence of multidrug resistance in identified bacteria will be assessed. Patients will be screened for colonization with the targeted antibiotic-resistant pathogens (i.e., MRSA, VRE) on the first Tuesday of January, February, and March 1999. Prior patient exposure to antibiotics, ventilatory support, central venous lines, and immunosuppressives will be assessed.

Survey of vancomycin use: Increased use of vancomycin over the past 10 years has been linked to the emergence of vancomycin-resistant organisms, such as enterococcus and staphylococcal species. Prior vancomycin therapy is an independent risk factor for the acquisition of VRE. Data on vancomycin use in the pediatric population are limited, and CDC guidelines for judicious use of vancomycin have not specifically addressed use in pediatric facilities. A survey will be conducted to assess the conditions for which vancomycin is being used in children’s hospitals, including use of vancomycin in surgery, nephrology, neonatology, and hematology/oncology. The availability of microbiology and laboratory data related to vancomycin use also will be assessed. The purposes of the study are to:

• assess vancomycin use rates and determine the clinical settings in which vancomycin is administered to pediatric patients;

• provide data to CDC to assist in modification of guidelines for pediatrics;

• develop and implement guidelines and provide educational programs directed at appropriate and judicious use of vancomycin in pediatric settings.