Epidemiology of pediatric Acinetobacter spp bacteremia at a tertiary care center in Riyadh, Saudi Arabia.

Abstract

Background: Invasive Acinetobacter infection in children is associated with significant morbidity and fatality.

Objectives: Investigate the clinical characteristics, antimicrobial susceptibility, outcomes, and fatality-related risk factors of Acinetobacter bacteremia in children.

Design: A retrospective case series study.

Setting: King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.

Patients and methods: The study included children (aged 0-14 years) with a positive blood culture for Acinetobacter species from January 2015 to December 2022.

Main outcomes measures: Clinical characteristics, antimicrobial susceptibility, case fatality rate, and fatality-related risk factors.

Sample size: 42 children.

Results: 17 girls (40%) and 25 boys (60%) with a median age of 10.5 months [interquartile range (IQR): 2-48]. The most common underlying conditions were hematologic/oncologic disease (n=15, 36%) and congenital heart disease (n=12, 29%). Thirty-three patients (79%) developed Acinetobacter bacteremia as a hospital-acquired infection. The predominant species were A. calcoaceticus-A. baumannii complex (n=34, 45%) and A. baumannii (n=15, 36%). Common exposures within 30 days prior to infection were previous hospitalization (n=32, 76%), antimicrobial therapy (n=26, 62%), central line insertion (n=19, 45%), mechanical ventilation (n=16, 38%), surgery (n=15, 36%), immunosuppressive therapy (n=9, 21%) and dialysis (n=9, 21%). Furthermore, 14 patients (33%) exhibited multidrug resistance, and one patient (2%) developed meningitis. Following treatment, 33 patients (79%) recovered with a median treatment duration of 15 days (IQR=12-21), two patients (5%) experienced relapse while on treatment, and two patients (5%) exhibited recurrent infection. The case fatality rate was 12% (5/42) and all died within 10 days post-infection. In the univariable analysis of fatality-related risk factors showed that younger age (median 2 months [IQR: 1-2]) (P=.025), congenital heart disease (P=.018), and dialysis within 30 days prior to infection were significantly associated with fatality (P=.005).

Conclusion: In this study, children with Acinetobacter bacteremia often had a history of prior hospitalization, antimicrobial therapy, invasive procedures, and chronic underlying comorbidities, specifically congenital heart disease and hematologic/oncologic disorders. Additionally, younger age, congenital heart disease, and recent dialysis were associated with fatality in the univariable analysis.

Limitations: Small sample size, lack of multivariable analysis, lack of molecular epidemiologic data.