Bloodstream infections in pediatric patients
Babay, H.A.; Twum-Danso, K.; Kambal, A.M.; Al-Otaibi, F.E.
Saudi Medical Journal 26(10): 1555-1561
2005
ISSN/ISBN: 0379-5284 PMID: 16228055 Document Number: 584582
Objective: To describe the clinical, microbiological characteristics and outcome of bloodstream infections (BSIs) among paediatric patients at the King Khalid University Hospital, Riyadh, Saudi Arabia, during January-December 2004. Methods: The clinical data of all paediatric patients with positive blood cultures were collected. All isolates from these patients were identified and their antimicrobial susceptibilities were determined using MicroScan Walk Away 96. Results: 220 paediatric patients had BSI. 147 (67%) were males and 71 (32.2%) were from intensive care units (ICUs). 210 (95.4%) had single blood culture isolate. 173 (78.6%) of the isolates were Gram positive bacteria, including Staphylococcus epidermidis (55.4%), S. aureus (9.5%; 14% of which were methicillin-resistant), Streptococcus pneumoniae (4.5%; 40% of which were penicillin-resistant) and Enterococcus faecalis (4%). 44 (20%) isolates were Gram negative bacteria, including Escherichia coli and Klebsiella pneumoniae (3.6% each). Three isolates (1.3%) were Candida glabrata [Torulopsis glabrata]. None of the Gram positive isolates were vancomycin-resistant. Three K. pneumoniae and one Pseudomonas spp. isolates were multiresistant. 194 (88%) of BSI isolates were hospital-acquired. Fever was the most common presentation of paediatric patients (26%) with positive blood culture with no apparent focus of infection, followed by respiratory tract infections (n=26, 12%). Sepsis was observed in 7.7% of 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. Salmonella spp., Streptococcus pneumoniae and Pseudomonas spp. isolates were observed in patients with immunosuppressive disorders. The 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, ICU admission, indwelling catheterization, mechanical ventilation and prior antimicrobial use. Conclusions: Bloodstream infection is an important cause of morbidity and mortality in paediatric patients.