PICnIC: Paediatric Intensive Care and Infection Control
Background
Each year, around 20,000 children are admitted to paediatric intensive care units (PICUs) in the UK. Critically ill children are at a higher risk of hospital-acquired infections. Many of these infections are caused by ‘bad’ bacteria in the digestive tract, such as those in the mouth and stomach. When someone is very poorly, the number of ‘bad’ bacteria may rise and spread to other organs. This can then cause severe illnesses, such as pneumonia and sepsis, and lead to long-term health problems, increased hospital costs and even death.
All PICUs have several methods to reduce the risk of hospital-acquired infections, such as providing antibacterial gel on units. One possible method is to treat patients with antibiotics that stop the growth of bacteria in the digestive tract. This treatment is called selective decontamination of the digestive tract (SDD). It has been shown in adults to reduce the number of hospital-acquired infections and improve survival. However, it is unclear if it works in children.
The aim of the PICnIC pilot study is to determine the feasibility of conducting a larger scale study to compare the effects of SDD with standard infection control in critically ill children.
Design
368 children across six PICUs took part in the study. The PICUs were randomly allocated to continue with their standard infection control procedures or to give SSD. The study also examined the views of patients, caregivers and healthcare professionals to assess their opinions on the feasibility of a larger scale study.
Results
The PICnIC study had a higher than average recruitment rate when compared with other UK PICUs and recruited children were representative of the wider PICU population. The majority of children received their allocated treatment according to the study guidelines. Parents and staff found the study to be acceptable with adaptations, such as including further training to improve consent and communication. Clinical outcomes that were considered important included duration of organ failure and hospital stay, healthcare-acquired infections and survival.
Conclusion
These findings indicate that a larger scale trial is feasible with some modifications to the inclusion criteria.
Who led the study?
Dr Nazima Pathan, University of Cambridge
This study is funded by the National Institute for Health Research (NIHR) – Health Technology Assessment (HTA) Programme (Project: 16/152/01)
Publications
Kean IRL, Clark JA, Zhang Z, Daubney E, White D, Ferrando-Vivas P, Milla G, Cuthbertson B, Pappachan J, Klein N, Mouncey P, Rowan K, Myburgh J, Gouliouris T, Baker S, Parkhill J, Pathan N, Arctic Research T. Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study). Gut 2024; . http://dx.doi.org/10.1136/gutjnl-2023-330851 Brown A, Ferrando P, Popa M, de la Fuente GM, Pappachan J, Cuthbertson B, Drikite L, Feltbower R, Gouliouris T, Sale I, Shulman R, Tume LN, Myburgh J, Woolfall K, Harrison DA, Mouncey PR, Rowan KM, Pathan N. Use of selective gut decontamination in critically ill children: protocol for the Paediatric Intensive Care and Infection Control (PICnIC) pilot study. BMJ Open 2022; 12(3):e061838. http://dx.doi.org/10.1136/bmjopen-2022-061838 Pathan N, Woolfall K, Popa M, de la Fuente GM, Ferrando-Vivas P, Brown A, Gouliouris T, Tume LN, Shulman R, Cuthbertson BH, Sale I, Feltbower RG, Myburgh J, Pappachan J, Harrison D, Mouncey P, Rowan K. Selective digestive tract decontamination to prevent healthcare associated infections in critically ill children: the PICNIC multicentre randomised pilot clinical trial. Sci Rep 2023; 13(1):21668. http://dx.doi.org/10.1038/s41598-023-46232-7
