Gram-negative bacteremia, the risk factors, and outcome in children

Diagn Microbiol Infect Dis. 2024 Jul;109(3):116324. doi: 10.1016/j.diagmicrobio.2024.116324. Epub 2024 Apr 23.

Abstract

We aimed to determine the epidemiology and resistance patterns of Gram-negative bacteria, the risk factors and outcome of bloodstream infection (BSI). In all, 412 episodes in children who were hospitalized with the diagnosis of bacteremia were analyzed. The most common microorganisms were Klebsiella spp. (43.9%), Escherichia coli (13.5 %) and Acinetobacter spp. (10.6 %). Among isolates, 41.2 % were multidrug-resistant, 13.5 % were extensively drug-resistant and 0.4 % were pan-drug-resistant. Carbapenem resistance was revealed in 27.6 % of isolates. Carbapenem and colistin resistance increased over the years. The most common risk factors were the presence of a central-venous catheter and pediatric intensive care unit admission. Clinical response and infection-related mortality were significantly different in cases infected with carbapenem-resistant gram-negative (CRGN) vs carbapenem-susceptible gram-negative bacteria. The increase in multi-resistant Klebsiella spp. seems to be the biggest obstacles in fight against nosocomial infections. The increasing number of CRGN infections over the years affects both the clinical response and mortality rate of BSI.

Keywords: Bloodstream infections; Catheters; Nosocomial infections; Pediatric.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents* / pharmacology
  • Anti-Bacterial Agents* / therapeutic use
  • Bacteremia* / drug therapy
  • Bacteremia* / epidemiology
  • Bacteremia* / microbiology
  • Bacteremia* / mortality
  • Carbapenems / pharmacology
  • Carbapenems / therapeutic use
  • Child
  • Child, Preschool
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Gram-Negative Bacteria* / classification
  • Gram-Negative Bacteria* / drug effects
  • Gram-Negative Bacteria* / isolation & purification
  • Gram-Negative Bacterial Infections* / drug therapy
  • Gram-Negative Bacterial Infections* / epidemiology
  • Gram-Negative Bacterial Infections* / microbiology
  • Gram-Negative Bacterial Infections* / mortality
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Microbial Sensitivity Tests
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Carbapenems