Risk Factors of Bloodstream Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Pediatric Critical Care Settings

Abstract

Aim:Infections and sepsis are the leading causes of death in non-cardiac intensive care units (ICUs) and account for 40 percent of all ICU expenditures. Data regarding bloodstream infections (BSIs) due to a carbapenem-resistant gram negative (CRGN) microorganisms in pediatric ICUs still remain limited.Materials and Methods:This study was conducted retrospectively in patients who were admitted to two pediatric critical care units between January 2011 and December 2017. Patients were assigned to two groups. Patients with BSI caused by a CRGN microorganism and infections were assigned to the BSI group and those other than BSI were assigned to the non-BSI group.Results:This study included 89 critically ill children with a mean age of 52.1 (±65.1) months. The requirements for invasive procedures including tracheostomy, Foley catheter and central venous catheter were not statistically different among the groups, p values were 0.159, 0.291 and 0.803, respectively. The majority of the patients admitted to pediatric intensive care unit were due to sepsis/septic shock in the BSI group (n=18, 58%) and in the non-BSI group, this figure was 37.9% (n=24). Prior third/fourth generation cephalosporin exposure was significantly more common in the BSI group (51.6% vs 15.5%, p<0.001), carbapenem exposure was not significantly different among the groups (35.5% vs 56.9%, p=0.054). Neutropenia (<500/mm3) and thrombocytopenia (150x103/mm3) were significantly more common in the BSI group (p=0.011 and p=0.010) and the C-reactive protein level was significantly higher (p=0.018). Crude and attributable mortality did not show any significance between the groups, p values were 0.578 and 0.955, respectively.Conclusion:CRGN infections are still a major cause of morbidity, mortality and healthcare associated infections. In this study, we evaluated patients with BSI due to a CRGN microorganism and compared them with other infection types. The risk factors and outcomes were similar except for prior cephalosporin exposure. As a conclusion, we have to enhance infection control programs and prevent patients from redundant antibiotic exposure.

Keywords

• Carbapenem-resistant gram-negative microorganism
• bloodstream infection
• pediatric critical care unit