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Bacterial Bloodstream Infections in Pediatric Intensive Care Units: A Multicenter Cohort Study to Investigate the
Patrícia de Oliveira Costa1,2,3, Shelley Ehrlich4, Ianick Souto Martins1,2
1From the Hospital do Câncer I, National Institute of Cancer, Rio de Janeiro, Rio de Janeiro, Brazil.
Insights
Multidrug-resistant bacterial bloodstream infections (BSIs) in critically ill children are linked to high mortality. Identifying risk factors like inappropriate therapy is crucial for improving outcomes in pediatric intensive care units (ICUs).
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Bloodstream infections (BSIs) significantly increase mortality in critically ill children.
- Multidrug-resistant (MDR) bacterial BSIs pose a therapeutic challenge due to limited treatment options.
- Understanding factors associated with mortality is vital for improving care.
Purpose of the Study:
- To identify clinical and healthcare-related factors associated with death in children with laboratory-confirmed BSIs (LC-BSIs).
- To specifically analyze the impact of MDR bacterial infections and appropriateness of antibiotic therapy on mortality.
- To investigate risk factors for both 30-day and 7-day mortality in pediatric intensive care unit (ICU) patients.
Main Methods:
- A prospective multicenter cohort study was conducted in Rio de Janeiro, Brazil, from January 2016 to December 2018.
- Included were children aged ≤18 years admitted to 9 ICUs with laboratory-confirmed BSIs (LC-BSIs).
- Multivariable logistic regression analyses were used to identify risk factors for 30-day and 7-day mortality.
Main Results:
- Out of 238 LC-BSI episodes, 31.1% were caused by MDR bacteria. Inappropriate initial and definitive antibiotic therapies were noted in 50.4% and 8.4% of cases, respectively.
- Overall 30-day and 7-day mortality rates were 18.5% and 8.8%.
- Factors independently associated with 30-day death included hematologic disease, high Pediatric Risk of Mortality (PRISM) score (≥20), vasopressor use, and ICU-acquired BSIs. Factors for 7-day death included inappropriate definitive therapy, certain primary conditions (infectious disease, congenital heart disease, hematologic disease), high PRISM score, vasopressor use, and BSIs secondary to respiratory or intra-abdominal infections.
Conclusions:
- Key clinical factors, such as primary condition and severity scores, are linked to mortality in pediatric BSIs.
- Healthcare-related factors, including appropriateness of antibiotic therapy and source of infection, significantly influence survival.
- These findings highlight critical areas for intervention to reduce mortality in critically ill children with BSIs.
Background:
Bloodstream infections (BSIs) are associated with a high mortality ratio among critically ill children. BSIs caused by multidrug-resistant (MDR) bacteria are a challenge due to limited therapeutic options. In this multicenter cohort study, factors associated with death of children with bacterial laboratory-confirmed BSI (LC-BSI) admitted to the intensive care unit (ICU) were analyzed, with a focus on MDR bacterial infection and appropriateness of therapy.
Methods:
A prospective cohort of children aged ≤18 years with LC-BSI, and admitted to 9 ICUs, was conducted from January 1, 2016, to December 31, 2018, in Rio de Janeiro, Brazil. Risk factors of 30- and 7-day death of LC-BSI were identified using multivariable logistic regression analyses.
Results:
Two hundred thirty-eight LC-BSI episodes occurred in 215 patients; 31.1% were caused by MDR bacteria. Inappropriate initial antibiotic therapy and definitive antibiotic therapy were administered in 50.4% and 8.4% of the episodes, respectively. The 30- and 7-day mortality ratios were 18.5% and 8.8%, respectively. Hematologic disease as primary condition, pediatric risk of mortality score ≥20 on date of LC-BSI, use of vasopressors, ICU-acquired BSI and LC-BSI from hospital B were independently associated with 30-day death. Inappropriate definitive antibiotic therapy; infectious disease, congenital heart disease and hematologic disease as primary conditions; PRISM score ≥20 at the time of LC-BSI; use of/vasopressors and LC-BSI secondary to respiratory tract or intra-abdominal infection were independently associated with 7-day death.
Conclusions:
Key clinical and healthcare-related factors associated with mortality in LC-BSI were identified.
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