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Enterobacter bacteremia in pediatric patients
1Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Enterobacter bacteremia is a serious infection in children, especially those under 18 months. This study highlights key risk factors and outcomes for pediatric Enterobacter infections.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Enterobacter species are increasingly recognized as significant human pathogens, particularly in vulnerable, hospitalized populations.
- Previous research on Enterobacter bacteremia has primarily focused on adult patients, leaving a gap in understanding pediatric cases.
- This study addresses the need for specific data on Enterobacter bacteremia in children.
Purpose of the Study:
- To review the epidemiologic factors, clinical characteristics, treatment, and outcomes of Enterobacter bacteremia in pediatric patients.
- To identify risk factors associated with increased mortality in children with Enterobacter bacteremia.
- To provide insights into the management and prognosis of this infection in a pediatric setting.
Main Methods:
- Retrospective review of 33 pediatric patients diagnosed with Enterobacter bacteremia over a 5-year period at a children's hospital.
- Analysis of demographic data, clinical presentation, underlying conditions, infection sources, and prior antibiotic use.
- Statistical analysis to determine factors associated with mortality, including age, thrombocytopenia, and fever.
Main Results:
- The study included 33 pediatric patients, with a male-to-female ratio of 1.2:1 and a wide age range (2 days to 24 years).
- A majority of cases (22/33) were nosocomially acquired, often associated with underlying conditions (32/33) and common sources like the biliary tract and central venous catheters.
- Overall mortality was 24%, with 18% directly attributable to Enterobacter bacteremia; younger age (<18 months) and thrombocytopenia were significant predictors of mortality.
Conclusions:
- Enterobacter bacteremia represents a significant cause of morbidity and mortality in pediatric patients, necessitating careful monitoring and management.
- Younger children, particularly those under 18 months, and patients with thrombocytopenia face a higher risk of mortality.
- The findings underscore the importance of recognizing Enterobacter as a critical pathogen in pediatric healthcare settings and highlight areas for potential intervention.
Abstract:
Enterobacter has emerged as an important human pathogen, particularly in sick, hospitalized patients. Previous reports of nonepidemic enterobacter bacteremia have focused on adult patients. In this report, the epidemiologic factors, clinical characteristics, treatment, and outcome for 33 patients with enterobacter bacteremia in a large children's hospital during a 5-year period are reviewed. The ratio of males to females was 1.2:1. The patients' ages ranged from 2 days to 24 years, and 18 patients were less than 18 months old. Twenty-two cases were nosocomially acquired; six were polymicrobial in nature. Significantly underlying conditions were present in 32 patients. The biliary tract and central venous catheters were the most common sources of bacteremia. Two-thirds of patients had preceding antibiotic therapy. The overall mortality was 24%; mortality attributable to enterobacter bacteremia was 18%. Statistically significant differences in mortality were associated with an age less than 18 months (P = .031) or thrombocytopenia (P = .017); presence of fever was of borderline significance (P = .098). Enterobacter bacteremia is an important cause of morbidity and mortality in pediatric patients.