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Risk Factors for Bloodstream Infections in Critically Ill Children: Gram-Negative Predominance and Complex Chronic

Vanessa Vicenzi1, Ian Teixeira E Sousa1, Jefferson Pedro Piva2

  • 1Postgraduate Program in Child and Adolescent Health, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.

Acta Paediatrica (Oslo, Norway : 1992)
|August 7, 2025
PubMed

Insights

Hospital-acquired bloodstream infections (BSIs) in paediatric intensive care units (PICUs) are common. Gram-negative bacteria were the most frequent cause, linked to oncohaematologic disease, while catheter use predicted fungal infections.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Paediatrics

Background:

  • Bloodstream infections (BSIs) are a major cause of mortality in paediatric intensive care units (PICUs).
  • Identifying specific risk factors for hospital-acquired BSIs (HA-BSIs) is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify risk factors associated with the aetiology of HA-BSIs in a Brazilian PICU.
  • To determine the outcomes and mortality predictors for children with HA-BSIs.

Main Methods:

  • Retrospective analysis of 422 blood cultures with pathogenic growth from 2018-2021.
  • Data collected included underlying conditions, central venous catheter use, and length of PICU stay.
  • Logistic regression was used to assess the association between BSI aetiology and mortality.

Main Results:

  • Gram-negative bacteria (43.2%) predominated, followed by Gram-positive bacteria (41.2%) and fungi (15.5%).
  • Carbapenem resistance was noted in 26.5% of Gram-negative isolates; Methicillin-resistant Staphylococcus aureus was 40.0% of S. aureus.
  • Fungal infections were strongly associated with catheter use (OR 9.0, p=0.039). Gram-negative infections linked to older age and oncohaematologic disease.
  • Overall mortality was 24.3%; vasoactive drug use was the sole independent mortality predictor (RR 3.2, p=0.004).

Conclusions:

  • Gram-negative bacteria are the leading cause of BSIs in this PICU population, particularly in children with oncohaematologic diseases.
  • Fungal BSIs are significantly associated with central venous catheter use.
  • Understanding these risk factors can guide empirical treatment strategies for critically ill children.
Abstract

Keywords:
aetiological agentbloodstream infectioncomplex chronic conditionsmortalitypaediatric intensive carerisk factors

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