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Pediatric bloodstream infections in metropolitan Australia
Shakif Mohammad Shakur1, John Whitehall1, Poonam Mudgil2
1School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
Insights
Pediatric bloodstream infections (BSIs) are often caused by Gram-positive bacteria. While most bacteria remain susceptible to common antibiotics, Escherichia coli shows high resistance to ampicillin and co-trimoxazole, necessitating careful treatment choices.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Antimicrobial resistance
Background:
- Bloodstream infections (BSIs) in children contribute significantly to global morbidity and mortality.
- Understanding causative organisms and their susceptibility is crucial for effective treatment.
Purpose of the Study:
- To investigate bloodstream infections in pediatric patients.
- Identify common causative organisms and their antimicrobial susceptibility patterns.
- Inform treatment strategies in a metropolitan Australian hospital.
Main Methods:
- Retrospective review of pediatric patients (0-16 years) with bloodstream infections.
- Analysis of patient demographics, isolated bacterial species, and antimicrobial susceptibility.
- Correlation of findings with clinical outcomes.
Main Results:
- Staphylococcus aureus, Escherichia coli, and Streptococcus pneumoniae were the most frequent isolates.
- Most bacteria showed over 90% susceptibility to common antimicrobials.
- Escherichia coli exhibited significant resistance to ampicillin (42.9%) and co-trimoxazole (41.7%).
Conclusions:
- Gram-positive bacteria, particularly Streptococcus pneumoniae, are major causes of pediatric BSIs.
- High resistance rates of Escherichia coli to ampicillin and co-trimoxazole confirmed.
- Empirical treatment should consider gentamicin; continuous monitoring of resistance patterns is essential.
Background:
Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide. The aim of this study was to investigate BSI in children and determine the identity of causative organism and their susceptibility patterns in a metropolitan public hospital in Australia.
Methods:
We retrospectively reviewed children aged 0-16 years admitted to a public hospital from January 1, 2010 to August 31, 2014 inclusive, and whose blood cultures revealed bacteraemia. Data were collected regarding patient demographics, species of bacteria isolated, antimicrobial susceptibility of these isolates, and clinical outcomes.
Results:
Out of 96 patients with BSI, 55 (57.3%) were males. The median age was 3.35 years (IQR 0.44-7.46), and there were 2 mortalities. Common sites of infection were the respiratory tract (16.6%, n = 16), bone and joints (15.6%, n = 15) and the urinary tract (11.5%, n = 11). The most frequent isolates were Staphylococcus aureus (27.0%), Escherichia coli (14.0%) and Streptococcus pneumoniae (12.0%). Whilst most bacterial isolates displayed susceptibility (> 90%) to common antimicrobial agents, only 57.1% (8/14) of Escherichia coli isolates were susceptible to ampicillin and 58.3% (7/12) were susceptible to co-trimoxazole.
Conclusions:
Gram-positive bacteria accounted for the majority of pediatric BSIs, of which invasive pneumococcal disease remains a noteworthy cause. The majority of isolates, except Escherichia coli, were susceptible to commonly used antimicrobials. This study confirms the knowledge of high rates of resistance of Escherichia coli to ampicillin. Therefore, empirical treatment should still include gentamicin. Monitoring of resistance patterns is warranted to ensure that antibiotic therapy remains appropriate.
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