Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children

Balázs Ivády, Éva Kenesei, Péter Tóth-Heyn, Gabriella Kertész, Klára Tárkányi, Csaba Kassa, Enikő Ujhelyi, Borbála Mikos, Erzsébet Sápi, Krisztina Varga-Heier, Gábor Guóth, D. Szabó

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. Methods: In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. Results: One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1–6.17, range 0–17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. Conclusion: Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.

Original languageEnglish
JournalInfection
DOIs
Publication statusAccepted/In press - Nov 6 2015

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Multiple Drug Resistance
Septic Shock
Pseudomonas
Infection
Enterobacter
Mortality
Pediatrics
Anti-Bacterial Agents
Child Mortality
Multiple Organ Failure
Parenteral Nutrition
Enterobacteriaceae
Cephalosporins
Coinfection
Multicenter Studies
Sepsis
Therapeutics
Prospective Studies
Escherichia coli
Bacteria

Keywords

  • Bloodstream infection
  • Gram negative
  • Multidrug resistant
  • Outcome
  • Pediatric
  • Sepsis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children. / Ivády, Balázs; Kenesei, Éva; Tóth-Heyn, Péter; Kertész, Gabriella; Tárkányi, Klára; Kassa, Csaba; Ujhelyi, Enikő; Mikos, Borbála; Sápi, Erzsébet; Varga-Heier, Krisztina; Guóth, Gábor; Szabó, D.

In: Infection, 06.11.2015.

Research output: Contribution to journalArticle

Ivády, B, Kenesei, É, Tóth-Heyn, P, Kertész, G, Tárkányi, K, Kassa, C, Ujhelyi, E, Mikos, B, Sápi, E, Varga-Heier, K, Guóth, G & Szabó, D 2015, 'Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children', Infection. https://doi.org/10.1007/s15010-015-0857-8
Ivády, Balázs ; Kenesei, Éva ; Tóth-Heyn, Péter ; Kertész, Gabriella ; Tárkányi, Klára ; Kassa, Csaba ; Ujhelyi, Enikő ; Mikos, Borbála ; Sápi, Erzsébet ; Varga-Heier, Krisztina ; Guóth, Gábor ; Szabó, D. / Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children. In: Infection. 2015.
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AU - Tárkányi, Klára

AU - Kassa, Csaba

AU - Ujhelyi, Enikő

AU - Mikos, Borbála

AU - Sápi, Erzsébet

AU - Varga-Heier, Krisztina

AU - Guóth, Gábor

AU - Szabó, D.

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N2 - Objective: The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. Methods: In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. Results: One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1–6.17, range 0–17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. Conclusion: Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.

AB - Objective: The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis. Methods: In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome. Results: One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1–6.17, range 0–17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome. Conclusion: Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.

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KW - Multidrug resistant

KW - Outcome

KW - Pediatric

KW - Sepsis

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