الفهرس 
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Abstract
Worldwide, Healthcare-associated infections are a major public health concern. The endemic burden of healthcare-associated infection is much higher among patients admitted to intensive care units. Younger children have a higher risk for infection, especially in developing countries. The most important intrinsic risk factors for HAI include extremes of age, malnutrition, the severity of the underlying illness, and a primary or secondary immunodeficiency. The extrinsic risk factors include surgery, invasive procedures, and the presence of invasive devices. The four most common types of HAIs are related to invasive devices or surgical procedures and include Central line-associated bloodstream infection (CLABSI), Ventilator-associated pneumonia (VAP), Catheter-associated urinary tract infection (CAUTI), and surgical site infection (SSI). The patient’s environment serves as a major reservoir of microorganisms. The emergency of multiple-drug-resistant bacteria in the environment is an important contributing factor to healthcare-associated infections (HAI).
This study aimed to evaluate the healthcare-associated infections among children admitted to Alexandria University Children’s Hospital to determine the prevalence, clinical and microbiological characteristics of HAIs and examine relatedness between the clusters of frequently isolated pathogens using the MALDI-TOF technique.
This study was conducted on children admitted to Alexandria University Pediatric Intensive Care Unit (PICU) and general wards, who acquired HAI from the first of March to the first of September 2019.
The current study included 3015 patients. During the study period Fifty patients (1.7%) developed 64 episodes of HAI with an overall incidence of 2.1 infections/100 patients, and the incidence density was 3.8 infections/1000 patient days. Of these episodes, pneumonia was the most common (39.1%) followed by bloodstream infections (34.4%) and finally urinary tract infection (26.5%).
The studied population had a median age 13 months with a slight male predominance (male 56%). More than half of the studied patients (52%, n=26) were admitted to PICU. The overall mortality among the studied population was 32%. Their mean PIM-2 and PEWS scores were relatively high (27.20 and 5 respectively).
Seventy-two organisms were isolated during HAI episodes. Gram-negative bacteria were the most isolated in 70.8% of cultures; Klebsiella pneumoniae spp was the most frequent isolated organism (34.7%). Klebsiella pneumoniae was the most common cause of healthcare-associated pneumonia and bloodstream infection representing 48% and 18.2% respectively however Enterococcus spp and Candida spp were the most common cause of UTI episodes representing 29.4% for each organism.
Regarding the susceptibility pattern of isolated organisms, multidrug-resistant strains were the most common predominating isolates in all types of HAI episodes: pneumonia (64%), BSI (77.3%), and UTI (52.9%).
The Klebsiella-infected group of patients sho