Background: Hospital-acquired infections (HAIs) in pediatric intensive care units (PICUs) pose a major global challenge, significantly increasing morbidity, mortality, and healthcare costs. This review aims to compare the rates, causes, and risk factors of HAIs in PICUs in Iran and developed countries to identify key differences and guide improvements.
Materials and Methods: In this narrative review, a literature search was conducted up to April 2025 in both English and Persian. Two independent reviewers used relevant keywords to search international databases including PubMed, Scopus, Web of Science, and Google Scholar, as well as Persian databases such as SID and CIVILICA. Data extraction focused on infection incidence, causative pathogens, associated risk factors, infection control measures, and patterns of antimicrobial resistance.
Results: This review shows that HAIs in PICUs in Iran reach up to 96.61 per 1,000 patient-days, notably higher than the 5 to 20 per 1,000 patient-days reported in developed countries. Predominant pathogens in Iran include multidrug-resistant Acinetobacter and Klebsiella, while developed countries report a broader range of pathogens. Device-associated infections, especially those linked to central venous catheters and respiratory equipment, are significant in both settings, but stricter preventive protocols reduce risks in developed countries. Antimicrobial resistance remains a key challenge in Iran but is managed more effectively in developed countries through stewardship and prevention programs. Continued improvements in healthcare infrastructure, specialized training, and infection control in Iran are enhancing care quality and reducing HAIs.
Conclusion: This review highlights a higher burden of hospital-acquired infections in Iranian PICUs compared to developed countries, driven by multidrug-resistant pathogens and limited resources. Advancing infection control, education, infrastructure, surveillance, and antibiotic stewardship is crucial to reduce infections and improve outcomes in resource-limited settings.