Balázs Ivády1,2, Éva Kenesei3, Péter Tóth-Heyn4, Gabriella Kertész5, Klára Tárkányi6, Csaba Kassa7, Enikő Ujhelyi8, Borbála Mikos9, Erzsébet Sápi10, Krisztina Varga-Heier11, Gábor Guóth12, Dóra Szabó13. 1. Department of Anesthesiology and Intensive Care, Heim Pál Children's Hospital, Üllői út 86, Budapest, 1089, Hungary. ivadybalazs@yahoo.com. 2. Institute of Medical Microbiology, Semmelweis University of Budapest, Budapest, Hungary. ivadybalazs@yahoo.com. 3. 1st Department of Pediatrics, Microbiology Laboratory, Semmelweis University of Budapest, Budapest, Hungary. 4. 1st Department of Pediatrics, Semmelweis University of Budapest, Budapest, Hungary. 5. 2nd Department of Pediatrics, Semmelweis University of Budapest, Budapest, Hungary. 6. Bacteriology Laboratory, Egyesített Szent Isván and Szent László Hospital, Budapest, Hungary. 7. Department for Pediatric Haematology and Stem Cell Transplantation, Egyesített Szent Isván and Szent László Hospital, Budapest, Hungary. 8. Pediatric Intensive Care Unit, Egyesített Szent Isván and Szent László Hospital, Budapest, Hungary. 9. Department of Anesthesiology and Intensive Care, Bethesda Childrens Hospital, Budapest, Hungary. 10. Center for Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary. 11. Faculty of Medicine, Semmelweis University, Budapest, Hungary. 12. Department of Pediatrics, Szent György Hospital of County Fejér, Szekesfehervar, Hungary. 13. Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary.
Abstract
OBJECTIVE: The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. METHODS: In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. RESULTS: One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1-6.17, range 0-17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. CONCLUSION: Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.
OBJECTIVE: The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. METHODS: In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. RESULTS: One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1-6.17, range 0-17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. CONCLUSION: Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.
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