Adam D Irwin1, Richard J Drew2, Philippa Marshall3, Kha Nguyen3, Emily Hoyle4, Kate A Macfarlane3, Hoying F Wong3, Ellen Mekonnen3, Matthew Hicks3, Tom Steele3, Christine Gerrard2, Fiona Hardiman2, Paul S McNamara3, Peter J Diggle5, Enitan D Carrol6. 1. Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; adam.irwin@liverpool.ac.uk. 2. Departments of Microbiology, and. 3. Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; 4. Pediatrics, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom; and. 5. Departments of Epidemiology and Population Health, and. 6. Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
Abstract
BACKGROUND: Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is associated with significant morbidity and mortality. Its evolving etiology may affect the ability of clinicians to initiate timely, appropriate antimicrobial therapy. METHODS: A retrospective time series analysis of bacteremia was conducted in the Alder Hey Children's Hospital ED between 2001 and 2011. Data on significant comorbidities, time to empirical therapy, and antibiotic susceptibility were recorded. RESULTS: A total of 575 clinical episodes were identified, and Streptococcus pneumoniae (n = 109), Neisseria meningitidis (n = 96), and Staphylococcus aureus (n = 89) were commonly isolated. The rate of bacteremia was 1.42 per 1000 ED attendances (95% confidence interval: 1.31-1.53). There was an annual reduction of 10.6% (6.6%-14.5%) in vaccine-preventable infections, and an annual increase of 6.7% (1.2%-12.5%) in Gram-negative infections. The pneumococcal conjugate vaccine was associated with a 49% (32%-74%) reduction in pneumococcal bacteremia. The rate of health care-associated bacteremia increased from 0.17 to 0.43 per 1000 ED attendances (P = .002). Susceptibility to empirical antibiotics was reduced (96.3%-82.6%; P < .001). Health care-associated bacteremia was associated with an increased length of stay of 3.9 days (95% confidence interval: 2.3-5.8). Median time to antibiotics was 184 minutes (interquartile range: 63-331) and 57 (interquartile range: 27-97) minutes longer in Gram-negative bacteremia than in vaccine-preventable bacteremia. CONCLUSIONS: Changes in the etiology of pediatric bacteremia have implications for prompt, appropriate empirical treatment. Increasingly, pediatric bacteremia in the ED is health care associated, which increases length of inpatient stay. Prompt, effective antimicrobial administration requires new tools to improve recognition, in addition to continued etiological surveillance.
BACKGROUND:Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is associated with significant morbidity and mortality. Its evolving etiology may affect the ability of clinicians to initiate timely, appropriate antimicrobial therapy. METHODS: A retrospective time series analysis of bacteremia was conducted in the Alder Hey Children's Hospital ED between 2001 and 2011. Data on significant comorbidities, time to empirical therapy, and antibiotic susceptibility were recorded. RESULTS: A total of 575 clinical episodes were identified, and Streptococcus pneumoniae (n = 109), Neisseria meningitidis (n = 96), and Staphylococcus aureus (n = 89) were commonly isolated. The rate of bacteremia was 1.42 per 1000 ED attendances (95% confidence interval: 1.31-1.53). There was an annual reduction of 10.6% (6.6%-14.5%) in vaccine-preventable infections, and an annual increase of 6.7% (1.2%-12.5%) in Gram-negative infections. The pneumococcal conjugate vaccine was associated with a 49% (32%-74%) reduction in pneumococcal bacteremia. The rate of health care-associated bacteremia increased from 0.17 to 0.43 per 1000 ED attendances (P = .002). Susceptibility to empirical antibiotics was reduced (96.3%-82.6%; P < .001). Health care-associated bacteremia was associated with an increased length of stay of 3.9 days (95% confidence interval: 2.3-5.8). Median time to antibiotics was 184 minutes (interquartile range: 63-331) and 57 (interquartile range: 27-97) minutes longer in Gram-negative bacteremia than in vaccine-preventable bacteremia. CONCLUSIONS: Changes in the etiology of pediatric bacteremia have implications for prompt, appropriate empirical treatment. Increasingly, pediatric bacteremia in the ED is health care associated, which increases length of inpatient stay. Prompt, effective antimicrobial administration requires new tools to improve recognition, in addition to continued etiological surveillance.
Authors: Paul Tran; Elaine Dowell; Stacey Hamilton; Susan A Dolan; Kevin Messacar; Samuel R Dominguez; James Todd Journal: Open Forum Infect Dis Date: 2020-01-27 Impact factor: 3.835
Authors: Maryke J Nielsen; Paul Baines; Rebecca Jennings; Sarah Siner; Ruwanthi Kolamunnage-Dona; Paul Newland; Matthew Peak; Christine Chesters; Graham Jeffers; Colin Downey; Caroline Broughton; Lynsey McColl; Jennifer Preston; Anthony McKeever; Stephane Paulus; Nigel Cunliffe; Enitan D Carrol Journal: PLoS One Date: 2021-02-05 Impact factor: 3.240
Authors: Simon Leigh; Alison Grant; Nicola Murray; Brian Faragher; Henal Desai; Samantha Dolan; Naeema Cabdi; James B Murray; Yasmin Rejaei; Stephanie Stewart; Karl Edwardson; Jason Dean; Bimal Mehta; Shunmay Yeung; Frans Coenen; Louis W Niessen; Enitan D Carrol Journal: BMC Med Date: 2019-03-06 Impact factor: 8.775