Original Article Occurrence of infection among children with nephrotic syndrome during hospitalizations CHANG-CHING WEI, 1 I-WEN YU, 2 HSIANG-WEN LIN 2,3 and ALAN C TSAI 4,5 1 Division of Pediatric Nephrology, Department of Pediatrics, 2 Department of Pharmacy, China Medical University Hospital, 3 Graduate Institute and School of Pharmacy, College of Pharmacy, 4 Department of Health Services, School of Public Health, China Medical University, and 5 Department of Healthcare Administration, Asia University, Wufeng, Taichung, Taiwan KEY WORDS: hospitalization, infection, nephrotic syndrome. Correspondence: Dr Hsiang-Wen Lin, School of Pharmacy and Graduate Institute, College of Pharmacy, China Medical University, Pharmacy Department, China Medical University Hospital, No. 91 Hsueh-Shih road, Taichung, 40402 Taiwan. Email: hsiangwl@mail.cmu.edu.tw, hsiangwl@yahoo.com Dr Alan C Tsai, Department of Healthcare Administration, Asia University, Wufeng, Taichung 413, Taiwan and Department of Health Services, School of Public Health, China Medical University, Taichung 404, Taiwan. Email: atsai@umich.edu Accepted for publication 28 July 2012. Accepted manuscript online 7 August 2012. doi:10.1111/j.1440-1797.2012.01650.x Disclosures: None. SUMMARY AT A GLANCE The authors report the incidence of infection and its associated factor in children with nephrotic syndrome (NS) from the viewpoint of public health in Taiwan, using the Taiwan National Health Insurance Database. ABSTRACT: Aim: The present study was conducted to investigate the trends of child- hood nephrotic syndrome (NS) admissions and factors associated with childhood NS admissions with major infections in Taiwan. Methods: A retrospective analysis was performed using Taiwan National Health Research Insurance Database (NHIRD) to explore the associated factors and health care burden for childhood NS admissions with major infections in 1997 to 2007. Results: Of 133 927 children, a total of 176 children had NS, which incurred 508 hospital admissions. Nineteen percent of admissions were associated with major infections. Pneumonia was the most common infection (49%), followed by urinary tract infection (UTI), bacteraemia/sepsis, peritonitis and cellulitis. Pneumonia was the most common infection among children age younger than 10 years, whereas UTI was more common among children aged greater than 10 years. NS admission with infections had longer periods of hospital length of stay and higher hospital total costs compared to those without infections. Regression analysis reveals that younger age, regional hospitals, admission hospital located in middle and south areas and admis- sion made in spring were associated with increased risk for developing major infections. Conclusions: While 19% of childhood NS admissions were associated with major infections, young age, admissions made in spring, located in middle and south Taiwan and in regional hospitals were the major associated factors for infection. Age plays an important role in risk and types of infection. INTRODUCTION Nephrotic syndrome (NS) is among the most common chronic kidney diseases occurring in childhood. The inci- dence of idiopathic NS is reported at two to three cases per 100 000 children. 1,2 Defence mechanisms are impaired in patients with NS due to its consequences of tissue oedema, urinary loss of immunoglobulin and complement and secondary effects to its treatment, including steroids and other immunosuppressants. 2 Immune-compromised status of NS can result in increased susceptibility to various infec- tions, which are potentially serious and life-threatening without prompt diagnosis and treatment. 3 Major infections of NS include spontaneous bacterial peritonitis, bacter- aemia, sepsis, cellulitis, pneumonia and urinary tract infection (UTI). 4–8 Episodes of NS complicated with major infections usually require admission for aggressive treatment. NS complicated with infection can affect not Nephrology 17 (2012) 681–688 © 2012 The Authors Nephrology © 2012 Asian Pacific Society of Nephrology 681