HAIs remain global challenges, increasing morbidity, mortality, and hospital costs. This study evaluated state-level indicators of CLABSI, UTI, and VAP and the microbiological profile in pediatric ICUs in Ceará (2021–2024), aiming to identify trends and support preventive strategies. Cross-sectional, quantitative, descriptive, retrospective study using HAI notifications from monitored healthcare services in Ceará. ANVISA data were analyzed, collected in April 2025 via LimeSurvey, covering pediatric ICUs. CLABSI decreased between 2021 (5.28) and 2023 (2.94), but rose again in 2024 (3.57), suggesting partial control with persistent challenges. UTI increased gradually, from 4.2 (2021) to 4.5 (2024). VAP fell from 8.51 (2021) to 5.16 (2024), indicating improvement possibly linked to ventilator time review and adoption of preventive bundles. In percentiles, CLABSI P90 remained high: 8.52 (2021) and 8.03 (2024), signaling that at least 10% of services still have high incidences. For UTI, P90 varied from 6.30 (2021) to 9.62 (2024), showing a slight worsening in the highest-burden settings despite lower median values. For VAP, P90 dropped markedly from 21.99 (2021) to 9.35 (2024), indicating improvement in extreme cases; however, P75 was 7.22, showing substantial density persists in some hospitals. Percentiles 25 and 50 near zero for UTI demonstrated heterogeneity among services. In 2024, CVC use was 69.4%, urinary catheter use 25.6%, and mechanical ventilation use 46.5%, stable compared with prior years, helping explain densities: high device utilization is associated with higher HAI risk when preventive measures fail. In the pediatric ICU microbiological profile, Klebsiella pneumoniae remained predominant, but an increase in non-albicans Candida (24 cases in 2024) and Pseudomonas aeruginosa in UTIs (10 in 2023 to 26 in 2024) was notable, indicating the need to strengthen protocols for fungi and multidrug-resistant Gram-negatives. Progress was observed in reducing VAP and improving extreme percentiles, especially for CLABSI. However, persistence of high densities in part of the services, growth in UTIs, and increased pathogens such as non-albicans Candida and Pseudomonas aeruginosa reinforce the need for rigorous monitoring, continuous staff training, and ongoing review of invasive-device practices in pediatric ICUs.
Silva et al. (Sun,) studied this question.