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Published on: February 17, 2023

A Multicenter Evaluation of Gram-negative Bloodstream Infections in Children: Predictors of Carbapenem Resistance

Asli Arslan1, Sema Yildirim Arslan1, Zehra N Coskun2

  • 1From the Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, Turkey.

The Pediatric Infectious Disease Journal
|May 7, 2026
PubMed

Insights

Pediatric carbapenem-resistant Gram-negative infections are a significant threat. This study found high carbapenem resistance rates in Turkish children, linked to hospital factors and antibiotic use, highlighting the need for better control.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Pediatric carbapenem-resistant Gram-negative (CRGN) infections pose a serious global health challenge, contributing to significant morbidity and mortality.
  • Multicenter data on resistance drivers in pediatric populations are limited, necessitating further investigation.
  • This study addresses the need for data on CRGN infections in hospitalized children in Turkey.

Purpose of the Study:

  • To determine the prevalence and carbapenem resistance (CR) rates of Gram-negative bloodstream infections (GNBSI) in hospitalized children in Turkey.
  • To identify clinical risk factors associated with CRGN BSIs in pediatric patients.
  • To analyze the impact of prior antibiotic exposures on carbapenem resistance.

Main Methods:

  • A 1-month point prevalence study was conducted across 27 tertiary hospitals in November 2023.
  • Included hospitalized patients aged 1 month to 18 years with laboratory-confirmed GNBSI.
  • Independent risk factors and prior antibiotic exposures were analyzed using regression models.

Main Results:

  • A total of 180 GNBSI cases were identified among 15,249 patients (prevalence: 1.19%).
  • Key pathogens included K. pneumoniae, E. coli, and P. aeruginosa, with an overall CR rate of 33.3%.
  • University hospital setting, central venous catheterization, mechanical ventilation, and steroid use were independent risk factors for CRGN BSIs. Prolonged exposure to certain antibiotics increased CR odds.

Conclusions:

  • A high burden of carbapenem resistance in pediatric Gram-negative bloodstream infections was observed in Turkey.
  • Modifiable risk factors and a high prevalence of multidrug-resistant isolates underscore the urgent need for improved infection control.
  • Robust antimicrobial stewardship programs are essential to combat the rising threat of pediatric CRGN infections.
Abstract

Keywords:
Gram-negative bloodstream infectionscarbapenem resistancecolistinmeropenem

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