Quantifying the burden of hospital-acquired bloodstream infection in children in England by estimating excess length of hospital stay and mortality using a multistate analysis of linked, routinely collected data

N. Green*, Alan Johnson, K. L. Henderson, Berit Muller-Pebody, S. Thelwall, Julie Robotham, M. Sharland, M. Wolkewitz, S. R. Deeny

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

Background. Hospital-acquired bloodstream infection (HA-BSI) is associated with substantial morbidity, mortality, and healthcare costs in all patient populations. Young children have been shown to have a high rate of healthcare-associated infections compared with the adult population. We aimed to quantify the excess mortality and length of stay in pediatric patients from HA-BSI. Methods. We analyzed data collected retrospectively from a probabilistically linked national database of pediatric (aged 1 month-18 years) in-patients with a microbiologically confirmed HA-BSI in England between January and March 2009. A time-dependent Cox regression model was fit to determine the presence of any effect. Furthermore, a multistate model, adjusted for the time to onset of HA-BSI, was used to compare outcomes in patients with HA-BSI to those without HA-BSI. We further adjusted for patients' characteristics as recorded in hospital admission data. Results. The dataset comprised 333 605 patients, with 214 cases of HA-BSI. After adjustment for time to HA-BSI and comorbidities, the hazard for discharge (dead or alive) from hospital for patients with HA-BSI was 0.9 times (95% confidence interval [CI], .8-1.1) that of noninfected patients. Excess length of stay associated with all-cause HA-BSI was 1.6 days (95% CI, .2-3.0), although this duration varied by pathogen. Patients with HA-BSI had a 3.6 (95% CI, 1.3-10.4) times higher hazard for in-hospital death than noninfected patients. Conclusions. Hospital-acquired bloodstream infection increased the length of stay and mortality of pediatric inpatients. The results of this study provide an evidence base to judge the health and economic impact of programs to prevent and control HA-BSI in children.

Original languageEnglish
Pages (from-to)305-312
Number of pages8
JournalJournal of the Pediatric Infectious Diseases Society
Volume4
Issue number4
DOIs
Publication statusPublished - Dec 2015

Bibliographical note

Publisher Copyright:
© The Author 2014.

Keywords

  • Length of stay
  • Multistate model
  • Pediatric

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