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Systematic review of invasive Acinetobacter infections in children
1Stollery Children's Hospital, University of Alberta, Edmonton, Alberta.
Insights
Acinetobacter infections in children commonly cause bacteremia and meningitis. Outbreaks primarily affect newborns, while community-acquired cases often occur in tropical regions.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Pathogenesis
- Nosocomial Infections
Background:
- Acinetobacter is a known cause of serious nosocomial infections in intensive care units.
- Limited comprehensive reviews exist on the full spectrum of invasive Acinetobacter infections specifically in pediatric populations.
Purpose of the Study:
- To systematically review and synthesize existing literature on invasive Acinetobacter infections in children.
- To characterize the clinical presentations, outbreak patterns, and outcomes of these infections in pediatric patients.
Main Methods:
- A systematic literature review was conducted up to December 2008.
- Studies reporting invasive Acinetobacter infections in children were included.
Main Results:
- 101 studies were identified, including outbreaks, case series, and case reports.
- Outbreaks were concentrated in neonatal intensive care units, often involving bacteremia or meningitis.
- Case series highlighted bacteremia and meningitis in children under five, with community-acquired infections frequently reported from India. Attributable mortality was 14.5%.
Conclusions:
- Invasive Acinetobacter infections in children typically present as bacteremia or meningitis but can have diverse clinical manifestations.
- Outbreaks are a concern in neonates with comorbidities, and community-acquired infections are prevalent in tropical areas.
- Further research into colonization and infection mechanisms in intensive care units and neonates in tropical regions may inform prevention strategies.
Introduction:
Clinicians are generally familiar with Acinetobacter as an etiological agent for serious nosocomial infections in intensive care units. However, there are no previous reviews of the full spectrum of invasive infections in children.
Methods:
A systematic review of the literature was completed up to December 2008 for reports of invasive Acinetobacter infections in children.
Results:
There were 101 studies that met the inclusion criteria including 18 possible outbreaks, 33 case series and 49 case reports. Suspected outbreaks were concentrated in neonatal intensive care units (16 of 18 outbreaks) and involved bacteremia or meningitis. Proof of isolate clonality or identification of the source of the outbreak was seldom established. Case series were primarily of children younger than five years of age presenting with bacteremia (sometimes multiresistant), meningitis, endocarditis or endophthalmitis, with many community-acquired infections being reported from India. Case reports consisted of unique presentations of disease or the use of novel therapies. Attributable mortality in the outbreaks and case series combined was 68 of 469 (14.5%).
Discussion:
Invasive Acinetobacter infections in children usually manifest as bacteremia, meningitis or both, but can result in a wide variety of clinical presentations. Outbreaks are primarily a problem in newborns with underlying medical conditions. Most reports of community-acquired infections are from tropical countries. The study of the mechanism of colonization and infection of children in intensive care units and of neonates in tropical countries may provide some insight into prevention of invasive infections.
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