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A 7-year study of bloodstream infections in an English children's hospital
1Department of Microbiology, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH, Birmingham, UK. jim.gray@bch.nhs.uk
Insights
Bloodstream infections (BSIs) in children are often linked to intravascular devices. Antibiotic resistance is increasing, necessitating updated infection control strategies and antibiotic policies.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Understanding bloodstream infection (BSI) patterns is crucial for guiding antibiotic prescribing and infection control.
- Intravascular devices (IVDs) are a significant source of BSIs in pediatric populations.
- Antibiotic resistance trends in pediatric BSIs require continuous monitoring.
Purpose of the Study:
- To analyze the epidemiological patterns and microbiological characteristics of bloodstream infections in children.
- To identify the primary sources and causative agents of BSIs in a pediatric hospital setting.
- To assess trends in antibiotic resistance among common BSI pathogens and evaluate associated mortality.
Main Methods:
- Prospective data collection of 2364 consecutive BSI episodes over 7 years at Birmingham Children's Hospital.
- Analysis of isolate species distribution (Gram-positive, Gram-negative, anaerobic bacteria, yeasts).
- Assessment of community-acquired vs. hospital-acquired infections, sources of infection (especially IVDs), and antibiotic resistance patterns.
Main Results:
- Intravascular devices were the most common source (48.9%) of BSIs.
- Gram-positive bacteria predominated (66.2%), with coagulase-negative staphylococci, Staphylococcus aureus, and enterococci being most frequent.
- Increased antibiotic resistance was observed, particularly in Enterobacteriaceae, S. aureus, and enterococci, with an overall mortality rate of 2.4%.
Conclusions:
- Intravascular devices are the leading cause of pediatric BSIs, contributing to similar isolate profiles across specialties.
- Frequent antibiotic resistance in common pathogens highlights the need for localized infection control interventions.
- While overall mortality is low, higher rates in neonates and previously healthy children with community-acquired infections warrant attention.
Unlabelled:
Knowledge of the pattern of bloodstream infection (BSI) can help determine antibiotic prescribing policy and infection control procedures. Data on 2364 consecutive episodes of BSI at Birmingham Children's Hospital over 7 years were collected prospectively. A total of 1224 (51.8%) episodes were community-acquired, but only 281 (11.9%) were in previously healthy children. Intravascular devices (IVDs) were the most common source of infection, accounting for 48.9% of episodes. Gram-positive, gram-negative and anaerobic bacteria accounted for 66.2%, 31.3% and 0.4% of isolates, and 2.2% were yeasts. Coagulase-negative staphylococci, Staphylococcus aureus and enterococci accounted for over 50% of all isolates. Of these, only enterococci were predominantly hospital-acquired. Neisseria meningitidis was the most common cause of community-acquired BSI in previously healthy children. Of cases of meningococcaemia, 55.6% were diagnosed by PCR alone. Antibiotic resistance, especially in Enterobacteriaceae, S. aureus and enterococci, was more common than in earlier studies of BSI in children, and varied between specialties. The overall mortality rate directly attributable to infection was 2.4%, but was higher in neonates (6.2%) and in previously healthy children with community-acquired infections (5.3%).
Conclusion:
Intravascular devices have emerged as the commonest source of bloodstream infection in children, leading to marked similarities in the species distribution of blood culture isolates across specialties other than General Paediatrics, and explaining the low overall mortality rate. Antibiotic resistance was found frequently in most commonly isolated pathogens, but differences between specialties suggest the existence of local risk factors, some of which might be amenable to infection control interventions.
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