Bloodstream infections in pediatric patients

OBJECTIVE: Blood stream infection (BSI) is the leading cause of morbidity and mortality in pediatric patients. This study aims to describe the clinical, microbiological characteristics and outcome of BSI in pediatric patients.

METHODS: We collected the clinical data from all pediatric patients with positive blood cultures. We identified all isolates from these patients from January 2004 to December 2004 at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, and determined antimicrobial susceptibilities by MicroScan Walk Away 96 (Dade Behring Inc., West Sacramento, CA95691, USA).

RESULTS: Two hundred and twenty pediatric patients had BSI, of whom 147 (67%) were males and 71 (32.2%) were from intensive care units (ICUs). Two hundred and ten (95.4%) had single blood culture isolate. One hundred and seventy-three (78.6%) of the isolates were Gram positive bacteria and included the following: Staphylococcus epidermidis (55.4%), Staphylococcus aureus (9.5%) of which 14% were methicillin resistant, Streptococcus pneumoniae (S. pneumoniae) (4.5%), 40% of which were resistant to penicillin and Enterococcus faecalis (4%). Gram negative bacteria were 44 (20%) and included Escherichia coli and Klebsiella pneumoniae (K.pneumoniae) (3.6% each). Three isolates (1.3%) were Candida glabrata. None of the Gram positive isolates were vancomycin resistant. Three K.pneumoniae and one Pseudomonas spp. isolates were multiresistant. One hundred and ninety-four (88%) of BSI isolates were hospital acquired. Fever was the most common presentation of pediatric patients (26%) with positive blood culture with no apparent focus of infection. Respiratory tract infections 26 (12%) were the next most common. We seen sepsis in (7.7%) children between 8 days and 6 months of age. Bone and joint infections, cardiac, renal, gastrointestinal diseases, malignancy and surgical cases were other associated clinical diagnoses of BSI in pediatric patients. Patients with immuno- suppressive disorders with BSI had isolates such as Salmonella spp., S. pneumoniae and Pseudomonas spp. Overall mortality was 13 (6%) (p<0.005) and those patients had underlying serious medical conditions with associated risk factors such as prolonged hospital stay, intensive care unit (ICU) admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use.

CONCLUSION: Bloodstream infection is an important cause of morbidity and mortality in pediatric patients. Risk factors for hospital acquired infection include: prematurity, prolonged hospitalization, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial therapy.