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Multidrug-resistant Gram-negative Bacterial Bloodstream Infections in Children's Hospitals in Japan, 2010-2017

Yuta Aizawa1,2, Takayo Shoji3, Kenta Ito4

  • 1From the Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.

The Pediatric Infectious Disease Journal
|January 24, 2019
PubMed

Insights

Multidrug-resistant Gram-negative bacilli bloodstream infections (MDR GNB BSI) in children are linked to cancer chemotherapy and older age. MDR GNB BSI did not significantly increase mortality rates in this pediatric study.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Hospital Epidemiology

Background:

  • Multidrug-resistant Gram-negative bacilli bloodstream infections (MDR GNB BSI) pose a significant threat in pediatric healthcare settings.
  • Risk factors and outcomes for MDR GNB BSI in children remain incompletely understood.
  • This study addresses the knowledge gap regarding pediatric MDR GNB BSI.

Purpose of the Study:

  • To identify risk factors associated with MDR GNB BSI in pediatric patients.
  • To evaluate the clinical outcomes of children experiencing MDR GNB BSI.
  • To compare MDR and non-MDR GNB BSI in a large cohort of children.

Main Methods:

  • Retrospective analysis of clinical and microbiological data from 629 GNB BSI episodes across 8 Japanese children's hospitals (April 2010-March 2017).
  • Comparison of risk factors and outcomes between multidrug-resistant (MDR) and non-multidrug-resistant (non-MDR) GNB BSI cases.
  • Statistical analysis to determine independent associations with MDR GNB BSI.

Main Results:

  • Multidrug-resistance (MDR) accounted for 24.5% of Gram-negative bacilli (GNB) bloodstream infections (BSI) in children, with no significant change over time.
  • Effective initial empiric therapy coverage was lower for MDR GNB BSI (60.4%) compared to non-MDR GNB BSI (83.4%).
  • Independent risk factors for MDR GNB BSI included recent cancer chemotherapy (OR 43.90), older age (OR 1.05), and neonatal ward admission (OR 0.019).

Conclusions:

  • Approximately one-fourth of pediatric GNB BSI cases were multidrug-resistant.
  • Cancer chemotherapy and older age are significant risk factors for developing MDR GNB BSI in pediatric hospitals.
  • MDR GNB BSI was not found to independently increase the 28-day all-cause mortality rate in this pediatric cohort.
Abstract

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