Nosocomial infections in brazilian pediatric patients: using a decision tree to identify high mortality groups
Braz. j. infect. dis
;
13(2): 111-117, Apr. 2009. tab, graf, ilus
Artículo
en Inglés
| LILACS
| ID: lil-538215
ABSTRACT
Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Algoritmos
/
Árboles de Decisión
/
Infección Hospitalaria
Tipo de estudio:
Estudio de etiología
/
Evaluación Económica en Salud
/
Estudio de incidencia
/
Estudio observacional
/
Estudio pronóstico
/
Factores de riesgo
Límite:
Femenino
/
Humanos
/
Lactante
/
Masculino
/
Recién Nacido
País/Región como asunto:
America del Sur
/
Brasil
Idioma:
Inglés
Revista:
Braz. j. infect. dis
Asunto de la revista:
Enfermedades Transmisibles
Año:
2009
Tipo del documento:
Artículo
País de afiliación:
Brasil
/
Antillas Neerlandesas
Institución/País de afiliación:
FHEMIG/BR
/
Federal University of Minas Gerais/BR
/
School of Medicine/BR
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