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Published on: February 17, 2023
Clinical and microbiological characteristics of bacteremia in pediatric intensive care unit: a retrospective
Junli Shan1, Yan Gao2, Jiaqi Su2
1Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, Shandong Province, 250012, China.
Insights
Pediatric intensive care unit (PICU) bacteremia increases mortality risk. Early identification of risk factors like platelet count and lactate levels is crucial for improving survival in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Clinical microbiology
Background:
- Bacteremia in the pediatric intensive care unit (PICU) poses a significant threat to critically ill children.
- Prompt clinical recognition and intervention are vital to mitigate severe outcomes and prevent fatal progression.
Purpose of the Study:
- To analyze the clinical characteristics, causative organisms, antimicrobial resistance patterns, and mortality predictors in pediatric patients with bacteremia in the PICU.
- To identify factors associated with increased mortality and prolonged hospital stays in this vulnerable population.
Main Methods:
- A retrospective observational study analyzed data from 9,814 pediatric patients (28 days to 18 years) admitted to the PICU between 2010 and 2018.
- Clinical data, blood culture results, drug resistance profiles, and patient outcomes were extracted and analyzed.
Main Results:
- Bacteremia was identified in 6.42% of patients, with an in-hospital mortality rate of 12.70%.
- Patients with bacteremia exhibited distinct laboratory abnormalities, including lower platelet (PLT) counts and albumin, and higher C-reactive protein (CRP) and lactate levels.
- Independent predictors of mortality in bacteremic patients included PLT count, activated partial thromboplastin time (APTT), and lactate. Fungal and Gram-negative bacteremia, as well as multidrug-resistant infections, were associated with higher case fatality rates.
Conclusions:
- Bacteremia in the PICU is a significant independent risk factor for increased mortality.
- Early identification and management of risk factors, such as specific laboratory values and pathogen types, are essential for improving patient survival and clinical outcomes.
Purpose:
Children with bacteremia in the pediatric intensive care unit (PICU) are often in critical condition. Early recognition and treatment by clinicians are crucial to prevent the progression of bacteremia to fatal outcomes.
Methods:
This single-center, retrospective analytical observational study included 9,814 pediatric patients in the PICU, ranging from 28 days to 18 years of age. Data were drawn from the pediatric intensive care (PIC) database between 2010 and 2018. Clinical characteristics, organisms isolated from blood cultures, drug resistance patterns, and factors associated with mortality were analyzed.
Results:
Among the 9,814 patients, 630 (6.42%) had bacteremia, and 80 (12.70%) died during their hospital stay. Patients with bacteremia had lower levels of platelet (PLT) count, hemoglobin, potential of hydrogen (pH), arterial oxygen partial pressure (PaO2), sodium, and albumin, and higher levels of lactic dehydrogenase (LDH), alanine transaminase (ALT), activated partial thromboplastin time (APTT), prothrombin time (PT), D-dimer, C-reactive protein (CRP), and lactate (all P < 0.05). These patients also had increased hospital and ICU stays, along with higher in-hospital mortality compared to those without bacteremia. Age, APTT, CRP, and albumin were independent factors significantly associated with bacteremia in the PICU. A total of 728 pathogenic strains were isolated, including Gram-positive bacteria (70.05%), Gram-negative bacteria (23.90%), and fungi (6.04%). The highest case fatality rate (CFR) was observed in children with fungal septicemia (27.27%), followed by Gram-negative bacteremia (22.41%) and Gram-positive bacteremia (8.88%). The CFR was also higher in cases with multiple infections (20.34%) and multidrug-resistant (MDR) infections (14.43%). Multivariable logistic regression analysis revealed that PLT, APTT, and lactate were independent factors significantly associated with mortality in patients with bacteremia.
Conclusions:
Bacteremia in the PICU is associated with an increased mortality rate. Clinicians must identify and manage the risk factors associated with poor clinical prognosis early to improve the survival prospects of patients with bacteremia.
