Abstract
BackgroundNosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.MethodsWe identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).ResultsIn our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.ConclusionsIn our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
Highlights
Nosocomial bloodstream infections are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients [1,2,3,4]
The rates of antimicrobial resistance among pathogens causing healthcare associated infection are increasing, mainly among gram-negative organisms (Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae) [8]. This increase in antimicrobial resistance demonstrates a need for surveillance programs to define the species distribution and the resistance patterns of pathogens that can cause a Nosocomial bloodstream infections (nBSIs) in order to help physicians choose the most appropriate antimicrobial treatment for hospitalized patients [9]
The purpose of this study was to evaluate the epidemiological features of nBSI, the species distribution and the antimicrobial susceptibility of the pathogens in pediatric patients, using the same methodology of prior studies (US and Brazilian SCOPE Projects) [9,12]
Summary
Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients [1,2,3,4]. Despite advances in antimicrobial treatment, nBSI prolongs hospital stay, increases direct patient care costs and directly causes mortality [6,7]. The rates of antimicrobial resistance among pathogens causing healthcare associated infection are increasing, mainly among gram-negative organisms (Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae) [8]. This increase in antimicrobial resistance demonstrates a need for surveillance programs to define the species distribution and the resistance patterns of pathogens that can cause a nBSI in order to help physicians choose the most appropriate antimicrobial treatment for hospitalized patients [9].
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