DOI: 10.1097/01.ccm.0000474613.33480.5e

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Issn Print: 0090-3493

Publication Date: 2015/12/01


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785: DURATION OF MECHANICAL VENTILATION IS ASSOCIATED WITH HIGHER RISK OF C DIFFICILE AND MRSA INFECTIONS

Natalia Martinez-Schlurmann; Sankeerth Rampa; Veerasathpurush Allareddy; Alexandre Rotta; Veerajalandhar Allareddy

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Learning Objectives: Acute Respiratory failure (ARF) needing invasive mechanical ventilation (IMV) is a common occurrence in PICUs. Hospital acquired infections (HAI) such as C difficile and MRSA are a major cause of morbidity and mortality, and are important quality metrics. It is unclear whether duration of IMV is an independent predictor of occurrence of such HAIs. We sought to examine the impact of prolonged (>96 hr) IMV on occurrence of MRSA and C. difficile infection (CDI) in children hospitalized with acute respiratory failure (ARF). We hypothesized that prolonged IMV would be associated with higher risk of occurrence of CDI and MRSA.
Methods: The Nationwide Inpatient Sample for the yr 2006 to 2010 was used. All hospitalized children (<18 yr) with ARF requiring IMV were selected. The independent variable of interest was duration of IMV. The outcomes were occurrence of CDI and MRSA. The association between outcomes and duration of IMV was examined by multivariable logistic regression models. The confounding effects of age, sex, race, insurance status, co-morbid burden, hospital region, and hospital teaching status were adjusted in the analysis.
Results: During the study period a total of 124,810 hospitalized children had ARF and underwent IMV. The age groups included up to 1 year (43.8%), 2 to 10 yr (27.8%), and 11 to 18 yr (28.4%). Males comprised 57.5% of hospitalizations. The overall incidence rate of CDI and MRSA infections was 1.9% and 1.4% respectively. 47.2% of all hospitalizations had IMV of >96 hr. Following adjustment for patient and hospital level confounding factors, those who had IMV for > 96 hr were associated with higher odds for CDI (OR=2.89, 95% CI=2.38–3.52, p<0.001) and MRSA infections (OR=3.51, 2.59–4.76, p<0.001) when compared to those who had IMV for <96 hr.
Conclusions: In hospitalized children with acute respiratory failure needing IMV, the duration of mechanical ventilation (> 96hr) is an independent predictor of occurrence of CDI and MRSA. Strategies to decrease duration of IMV may be needed to optimize the risk of occurrence of assessed HAI.

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