Epidemiology of bloodstream infection among paediatric population in Hospital Kuala Lumpur from January 2016 until December 2017

Abstract

Background: Bloodstream infection (BSI) is a major cause of morbidity and mortality. The classification of infection into community-acquired, hospital-acquired, and healthcare-associated infection provides an educated guess on the possible etiological agents and appropriate empirical antimicrobial therapy to be instituted. This study aims to determine the etiological agents, the antimicrobial susceptibility patterns and the classification of infections among the paediatric population. Methods & Materials: A total of 5549 blood cultures were received from the paediatric population from January 2016 to December 2017. Negative blood cultures of 4534 were excluded, 309 blood cultures with poor identification/missing data/repetitive isolates were excluded. A further 403 isolates were excluded as contaminant organisms. A total of 303 isolates were included in this study which was obtained from 238 patients. The patients’ microbiological worksheets and medical notes were reviewed to determine the antimicrobial susceptibility patterns, demographic data, classification of infection and the outcome (survival versus death). Results: Most of the patients were in the age group of one to less than five years old (41%) with 58% male and 85% Malay patients. Common causes of BSI were Staphylococcus aureus (17%), followed by Klebsiella pneumoniae (15%), Acinetobacter baumanii (10%), Pseudomonas aeruginosa (10%) and Escherichia coli (6%). Sixty percent of BSI episodes were caused by gram-negative bacteria, 34% by gram-positive bacteria and 6% by fungi. Most of the infections were classified as hospital-acquired infections (72%), followed by healthcare-associated (20%) and community-acquired infections (8%). There were 33% of methicillin-resistant S. aureus, 53% of extended-spectrum beta-lactamase (ESBL) producing K. pneumoniae and 33% of ESBL producing Escherichia coli. The overall case fatality rate (CFR) was 27% with the highest CFR caused by Serratia marcescens (53.3%). Conclusion: The majority of bloodstream infections are hospital-acquired. Improvement in prevention strategies and revisions in antibiotic policies are important to overcome it.