BACKGROUND: Bloodstream infections (BSIs) are prevalent in the critical care setting and have high attributable morbidity and mortality. The purpose of this study was to identify factors that significantly contribute to immediate as well as eventual mortality in patients with bloodstream infections at a pediatric intensive care unit (PICU). METHODS: Retrospective review of 2097 clinical records from admissions to our PICU in a 2-year period. Two separate case-control models were used. In the first model, eventual mortality (EM CASES) reflected those patients with eventual mortality, and EM CONTROLS were those who survived. In the second, infection-related mortality (IRM) cases were those with infection-related mortality, defined as death within 7 days of BSI, and IRM CONTROLS were survivors past 7 days. Logistic regression was used to adjust for differences for 3 categories: patient characteristics, microbiology and treatment variables. RESULTS: We identified 74 separate episodes of bacteremia. Having an underlying malignancy or immunodeficiency was the only independently significant predictor of eventual mortality for BSI isolated within the PICU. Patients with infection-related mortality more likely had Gram-negative bacteremia and/or fungemia, were older and had inadequate initial empiric antibiotic treatment at the time BSI was diagnosed. CONCLUSIONS: Targeted and aggressive early interventions should guide the empiric treatment of BSIs, whereas prolonged broad spectrum treatment should be minimized to avoid the emergence of resistant pathogen organisms.
BACKGROUND: Bloodstream infections (BSIs) are prevalent in the critical care setting and have high attributable morbidity and mortality. The purpose of this study was to identify factors that significantly contribute to immediate as well as eventual mortality in patients with bloodstream infections at a pediatric intensive care unit (PICU). METHODS: Retrospective review of 2097 clinical records from admissions to our PICU in a 2-year period. Two separate case-control models were used. In the first model, eventual mortality (EM CASES) reflected those patients with eventual mortality, and EM CONTROLS were those who survived. In the second, infection-related mortality (IRM) cases were those with infection-related mortality, defined as death within 7 days of BSI, and IRM CONTROLS were survivors past 7 days. Logistic regression was used to adjust for differences for 3 categories: patient characteristics, microbiology and treatment variables. RESULTS: We identified 74 separate episodes of bacteremia. Having an underlying malignancy or immunodeficiency was the only independently significant predictor of eventual mortality for BSI isolated within the PICU. Patients with infection-related mortality more likely had Gram-negative bacteremia and/or fungemia, were older and had inadequate initial empiric antibiotic treatment at the time BSI was diagnosed. CONCLUSIONS: Targeted and aggressive early interventions should guide the empiric treatment of BSIs, whereas prolonged broad spectrum treatment should be minimized to avoid the emergence of resistant pathogen organisms.
Authors: Aaron M Milstone; Alexis Elward; Xiaoyan Song; Danielle M Zerr; Rachel Orscheln; Kathleen Speck; Daniel Obeng; Nicholas G Reich; Susan E Coffin; Trish M Perl Journal: Lancet Date: 2013-01-28 Impact factor: 79.321
Authors: Robbert S A Mohammedamin; Johannes C van der Wouden; Sander Koning; Sten P Willemsen; Roos M D Bernsen; François G Schellevis; Lisette W A van Suijlekom-Smit; Bart W Koes Journal: BMC Fam Pract Date: 2006-08-31 Impact factor: 2.497
Authors: Sandra Pong; Robert A Fowler; Srinivas Murthy; Jeffrey M Pernica; Elaine Gilfoyle; Patricia Fontela; Asgar H Rishu; Nicholas Mitsakakis; James S Hutchison; Michelle Science; Winnie Seto; Philippe Jouvet; Nick Daneman Journal: BMC Pediatr Date: 2022-04-05 Impact factor: 2.125
Authors: Sandra Pong; Robert A Fowler; Srinivas Murthy; Jeffrey M Pernica; Elaine Gilfoyle; Patricia Fontela; Nicholas Mitsakakis; Asha C Bowen; Winnie Seto; Michelle Science; James S Hutchison; Philippe Jouvet; Asgar Rishu; Nick Daneman Journal: PLoS One Date: 2022-07-26 Impact factor: 3.752