The Etiologic Organisms, Risk Factors, and Outcomes of Nosocomial Bloodstream Infections in Pediatric Patients

Abstract

Much of the knowledge regarding pediatric healthcare-associated infections is based on studies conducted in adults. Here, we investigated clinical risk factors and etiologic organisms, focusing on antibiotic and antifungal resistance in pediatric patients with nosocomial bloodstream infections (nBSIs) in pediatric intensive care units (PICUs). A retrospective evaluation was conducted on pediatric patients with nBSI in the PICUs of a tertiary referral hospital. A total of 69 nBSI episodes in 65 patients were observed during the study period. Of these, a total of 40 (57.97%) were caused by Gram-negative bacteria, 6 (8.7%) by Gram-positive bacteria, and 23 (33.33%) by Candida species. The rankings of Gram-negative bacteria were Klebsiella pneumoniae (37.5%), Acinetobacter baumannii (22.5%), and Serratia marcescens (12.5%). Carbapenem resistance was found to be common among K. pneumoniae (40%) and all Acinetobacter species. Most children (54.41%) had spent >28 days in the PICU at the time of diagnosis of nBSI. The presence of central venous catheters was significantly associated with fungal nBSI (P = 0.047). A high rate of antimicrobial resistance was observed among pathogens. A central venous catheter was associated with fungemia in children hospitalized in PICUs. Prolonged hospital stay before the diagnosis of BSI and the use of medical devices were found to be common in fungal infections.