2 articles
Health care-associated bloodstream infections represent a major public health concern, significantly impacting morbidity, mortality, and the overall cost of pediatric medical care.
A literature review was conducted based on systematic searches in PubMed, SCOPUS, and Web of Science, following PRISMA guidelines.
The incidence of healthcare-associated bloodstream infections ranges from 2 to 25 cases per 1,000 central venous catheter days, with higher rates reported in pediatric and neonatal intensive care units, where patients are frequently exposed to risk factors such as central venous catheter use, mechanical ventilation, and immunosuppression. Pediatric patients with health care-associated bloodstream infections experience significantly longer hospital stays compared to those without infection (25 vs. 7 days, P < 0.0001). In pediatric intensive care units, the average length of hospital stay due to these infections varies between 11.40 and 21.10 days, while in neonatal intensive care units, it ranges from 4 to 27.80 days. Mortality associated with these infections among children varies between 15% and 50%, depending on the severity of infection and underlying comorbidities. Additionally, health care-associated bloodstream infections lead to increased use of medical resources and generate substantial additional costs for the healthcare system-costs that are, in fact, largely preventable.
Evidence-based strategies, such as strict hand hygiene and standardized protocols for medical device use, can significantly reduce the incidence of these infections.
Pulmonary thromboembolism (PTE) is a major cardiovascular emergency associated with significant mortality. Systemic inflammation contributes to the pathogenesis of thrombosis and to disease severity, and hematological indices derived from the complete blood count, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been proposed as prognostic predictors.
A prospective observational study was conducted on a cohort of 182 consecutively investigated patients at Holy Trinity Municipal Clinical Hospital and the Institute of Cardiology. The diagnosis of PTE was confirmed by CT pulmonary angiography. Clinical data, inflammatory hematological indices, echocardiographic parameters, and severity scores were analyzed during the course of inpatient care. The prognostic value of NLR and PLR was assessed using ROC curve analysis.
Pulmonary thromboembolism was confirmed in 153 patients (84.1%, 95% CI [78.7, 89.4]). Elevated NLR was identified in 82 patients (45.1%; 95% CI [37.8, 52.3]), and elevated PLR in 89 patients (48.9%; 95% CI [41.6, 56.2]). Overall mortality was 17.0% (95% CI [11.6, 22.5]) (31 patients). Elevated NLR was present in 26 (14.3; 95% CI [9.2, 19.4]) of deceased patients (p<0.00001), while elevated PLR was present in 22 (12.1%; 95% CI [7.4, 16.8]) of deceased patients (p = 0.012). ROC analysis demonstrated that NLR has a very good predictive ability for mortality (AUC = 0.799), whereas PLR has good predictive ability (AUC = 0.715). Additionally, NLR was significantly correlated with severity according to the PESI score (AUC = 0.614; p = 0.0048). Echocardiography revealed right ventricular dysfunction in 80.2% (95% CI [74.4, 86.0]) of patients and reduced TAPSE in 57.7% (95% CI [50.5, 64.9]) of patients.
The neutrophil-to-lymphocyte ratio is an important prognostic marker of severity and mortality in pulmonary thromboembolism, with a predictive value superior to that of the platelet-to-lymphocyte ratio. Integrating inflammatory hematological indices with clinical scores and imaging assessment may improve risk stratification and the management of patients with pulmonary thromboembolism.