Abstract

The etiology and outcomes of blood-stream infections (BSI) among paediatric patients is not well described in resource-limited countries including Georgia. Patients with positive blood cultures at the largest paediatric hospital in the country of Georgia were identified by review of the medical and laboratory records of patients who had blood for cultures drawn between January 2004 and June 2006. Of 1,693 blood cultures obtained during the study period, 338 (20%) were positive; of these, 299 were included in our analysis. The median age was 14 days from a range of 2 days to 14 years of which 178 (60%) were male; 53% of the patients with a positive culture were admitted to the Neonatal Intensive Care Unit (NICU). Gram-negative bacilli (GNB) represented 165 (55%) of 299 cultures. Further speciation of 135 (82%) of 165 Gram-negative rod (GNR) was not possible because of lack of laboratory capacity. Overall, mortality was 30% (90 of 299). Among the 90 children who died, 80 (89%) were neonates and 68 (76%) had BSI caused by Gram-negative organisms. In multivariate analysis, independent risk factors for in-hospital mortality included an age of less than 30 days (OR=4.00, 95% CI 1.89-8.46) and having a positive blood culture for a Gram-negative BSI (OR = 2.38, 95% CI 1.32-4.29). A high mortality rate was seen among children, particularly neonates, with positive blood cultures at the largest paediatric hospital in Georgia. Because of limited laboratory capacity, microbiological identification of common organisms known to cause BSI in children was not possible and susceptibility testing was not performed. Improving the infrastructure of diagnostic microbiology laboratories in countries with limited resources is critical in order to improve patient care and clinical outcomes, and from a public health standpoint, to improve surveillance activities.

Highlights

  • Georgia gained independence from the SovietUnion in 1991

  • The majority of patients were admitted to the CCH Neonatal Intensive Care Unit (NICU) (156 [53%] of 297 children); 75 (25%) were admitted to general neonatal departments; seven (2%) to the neurology neonatal department; 31 (10%) to the Paediatric Intensive Care Units (ICU); 17 (6%) to general paediatric departments; eight (3%) to the infectious diseases unit; and two (0.7%) who were seen in the Emergency Department were not admitted

  • Most (68%) positive blood cultures occurred among neonates, and Gram-negative bacteria and Coagulase negative Staphylococcus (CNS) were most commonly recovered from blood cultures (82%)

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Summary

Introduction

Georgia gained independence from the SovietUnion in 1991. Following independence, there was a collapse of the public health and medical infrastructure. The health care system in Georgia is currently undergoing many changes, moving from a centralized system based on the former Soviet model to a decentralized, market driven system [3]. There is a lack of information regarding rates of blood-stream infections among paediatric and adult patients in resource-limited areas. This is in part due to lack of laboratory infrastructure and surveillance capacity. There are limited data in Georgia regarding paediatric bloodstream infections and outcomes among patients with positive blood cultures. We conducted a study designed to determine the etiology and outcomes of paediatric patients with positive blood cultures in the country of Georgia. The etiology and outcomes of blood-stream infections (BSI) among paediatric patients is not well described in resource-limited countries including Georgia.

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