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Epidemiology of pediatric Acinetobacter spp bacteremia at a tertiary care center in Riyadh, Saudi Arabia
Deema Gashgarey1, Raghad Alhuthil1, Mohammed Alsuhaibani1,2
1From the Department of Pediatrics & Women Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Pediatric Acinetobacter bacteremia, often hospital-acquired, is linked to prior treatments and comorbidities. Younger age, congenital heart disease, and dialysis increase fatality risk in children.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Invasive Acinetobacter infections in children present significant morbidity and mortality risks.
- Understanding Acinetobacter bacteremia in pediatric populations is crucial for effective management.
Purpose of the Study:
- To investigate the clinical characteristics of pediatric Acinetobacter bacteremia.
- To determine antimicrobial susceptibility patterns.
- To identify outcomes and risk factors associated with fatality.
Main Methods:
- A retrospective case series was conducted at King Faisal Specialist Hospital and Research Centre.
- Data from children (0-14 years) with Acinetobacter bacteremia between January 2015 and December 2022 were analyzed.
- Clinical data, antimicrobial susceptibility, and fatality-related factors were assessed.
Main Results:
- Forty-two children were included, with most infections being hospital-acquired.
- The predominant species were Acinetobacter calcoaceticus-Acinetobacter baumannii complex and Acinetobacter baumannii.
- The case fatality rate was 12%, with younger age, congenital heart disease, and recent dialysis identified as risk factors for mortality.
Conclusions:
- Pediatric Acinetobacter bacteremia is frequently associated with prior hospitalizations, antimicrobial use, and invasive procedures.
- Congenital heart disease and hematologic/oncologic disorders are common comorbidities.
- Younger age, congenital heart disease, and recent dialysis are significant risk factors for fatality.
Background:
Invasive Acinetobacter infection in children is associated with significant morbidity and fatality.
Objectives:
Investigate the clinical characteristics, antimicrobial susceptibility, outcomes, and fatality-related risk factors of Acinetobacter bacteremia in children.
Design:
A retrospective case series study.
Setting:
King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.
Patients And Methods:
The study included children (aged 0-14 years) with a positive blood culture for Acinetobacter species from January 2015 to December 2022.
Main Outcomes Measures:
Clinical characteristics, antimicrobial susceptibility, case fatality rate, and fatality-related risk factors.
Sample Size:
42 children.
Results:
17 girls (40%) and 25 boys (60%) with a median age of 10.5 months [interquartile range (IQR): 2-48]. The most common underlying conditions were hematologic/oncologic disease (n=15, 36%) and congenital heart disease (n=12, 29%). Thirty-three patients (79%) developed Acinetobacter bacteremia as a hospital-acquired infection. The predominant species were A. calcoaceticus-A. baumannii complex (n=34, 45%) and A. baumannii (n=15, 36%). Common exposures within 30 days prior to infection were previous hospitalization (n=32, 76%), antimicrobial therapy (n=26, 62%), central line insertion (n=19, 45%), mechanical ventilation (n=16, 38%), surgery (n=15, 36%), immunosuppressive therapy (n=9, 21%) and dialysis (n=9, 21%). Furthermore, 14 patients (33%) exhibited multidrug resistance, and one patient (2%) developed meningitis. Following treatment, 33 patients (79%) recovered with a median treatment duration of 15 days (IQR=12-21), two patients (5%) experienced relapse while on treatment, and two patients (5%) exhibited recurrent infection. The case fatality rate was 12% (5/42) and all died within 10 days post-infection. In the univariable analysis of fatality-related risk factors showed that younger age (median 2 months [IQR: 1-2]) (P=.025), congenital heart disease (P=.018), and dialysis within 30 days prior to infection were significantly associated with fatality (P=.005).
Conclusion:
In this study, children with Acinetobacter bacteremia often had a history of prior hospitalization, antimicrobial therapy, invasive procedures, and chronic underlying comorbidities, specifically congenital heart disease and hematologic/oncologic disorders. Additionally, younger age, congenital heart disease, and recent dialysis were associated with fatality in the univariable analysis.
Limitations:
Small sample size, lack of multivariable analysis, lack of molecular epidemiologic data.
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