Predictors of mortality in children with nosocomial bloodstream infection

Area of Science:

• Pediatric Infectious Diseases
• Clinical Epidemiology
• Critical Care Medicine

Background:

• Nosocomial bloodstream infections (BSI) contribute significantly to pediatric mortality.
• Identifying predictors of mortality is crucial for effective prevention and management strategies.
• High case fatality rates underscore the need for improved clinical outcomes in pediatric BSI.

Purpose of the Study:

• To identify and evaluate clinical predictors of mortality in pediatric patients with nosocomial BSI.
• To assess the association between specific clinical factors and death in children diagnosed with hospital-acquired BSI.
• To provide evidence for targeted interventions to reduce mortality in pediatric nosocomial BSI.

Main Methods:

• Prospective cohort study conducted in a teaching hospital in Indonesia.
• Inclusion of patients admitted to pediatric intensive care units (PICU) and wards, observed for nosocomial BSI development.
• Logistic regression analysis employed to determine independent predictors of mortality.

Main Results:

• Out of 2646 patients, 170 (6.4%) developed nosocomial BSI, with 70 deaths (41% case fatality rate).
• Nosocomial BSI independently increased mortality risk (adjusted OR: 8.5).
• Malnutrition (aOR: 6.0), PICU admission (aOR: 3.2), and central line catheter use (aOR: 3.1) were significant independent predictors of death.

Conclusions:

• Nosocomial bloodstream infections are a major cause of mortality in pediatric patients.
• Simple clinical predictors such as malnutrition, PICU admission, and central line use can identify children at increased risk of death.
• These findings support the implementation of targeted preventive measures and clinical management for high-risk pediatric patients with nosocomial BSI.