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Risk factors for microbiologic failure in children with Enterobacter species bacteremia

Juri Boguniewicz1, Paula A Revell2,3, Michael E Scheurer4

  • 1Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United States of America.

Plos One
|October 7, 2021
PubMed

Insights

Recurrence of Enterobacter bloodstream infections (BSI) in children is uncommon, with microbiologic failure occurring in 6.7% of cases. Inadequate source control significantly predicts treatment failure in pediatric Enterobacter BSI.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Antimicrobial Resistance

Background:

  • Enterobacter species are a significant cause of healthcare-associated bloodstream infections (BSI) in children.
  • While recurrence of infection resistant to third-generation cephalosporins (3GCs) is noted in adults, data for children are limited.
  • Understanding recurrence and risk factors in pediatric Enterobacter BSI is crucial for effective treatment.

Purpose of the Study:

  • To investigate the incidence and risk factors for microbiologic failure in children with Enterobacter BSI.
  • To determine the rate of development of 3GC resistance following initial 3GC-susceptible Enterobacter BSI in pediatric patients.
  • To identify predictors of treatment failure in pediatric Enterobacter BSI.

Main Methods:

  • Retrospective case-control study of pediatric patients (≤21 years) with Enterobacter BSI at Texas Children's Hospital (2012-2018).
  • Primary outcome: microbiologic failure (72 hours to 30 days post-initial BSI).
  • Secondary outcome: development of 3GC non-susceptible Enterobacter isolate after a 3GC-susceptible isolate.

Main Results:

  • Microbiologic failure occurred in 6.7% of pediatric patients (12/180) with Enterobacter BSI.
  • Only 2.2% (3/138) of patients with initially 3GC-susceptible isolates developed subsequent non-susceptible infections.
  • Predictors of microbiologic failure included alternative primary infection sites (OR, 9.64) and inadequate source control (OR, 22.16).

Conclusions:

  • Adequacy of source control is a critical factor in preventing microbiologic failure in pediatric Enterobacter BSI.
  • In vitro susceptibility testing guides antibiotic selection for treating Enterobacter BSI in children.
  • Recurrence with resistant organisms is infrequent, but source control is paramount.
Abstract

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