Pediatric bloodstream infections in metropolitan Australia
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ORIGINAL ARTICLE
Pediatric bloodstream infections in metropolitan Australia Shakif Mohammad Shakur1 · John Whitehall1 · Poonam Mudgil1 Received: 16 October 2018 / Accepted: 16 December 2018 © Children’s Hospital, Zhejiang University School of Medicine 2019
Abstract Background Bloodstream infections (BSIs) cause significant morbidity and mortality of children worldwide. The aim of this study was to investigate BSI in children and determine the identity of causative organism and their susceptibility patterns in a metropolitan public hospital in Australia. Methods We retrospectively reviewed children aged 0–16 years admitted to a public hospital from January 1, 2010 to August 31, 2014 inclusive, and whose blood cultures revealed bacteraemia. Data were collected regarding patient demographics, species of bacteria isolated, antimicrobial susceptibility of these isolates, and clinical outcomes. Results Out of 96 patients with BSI, 55 (57.3%) were males. The median age was 3.35 years (IQR 0.44–7.46), and there were 2 mortalities. Common sites of infection were the respiratory tract (16.6%, n = 16), bone and joints (15.6%, n = 15) and the urinary tract (11.5%, n = 11). The most frequent isolates were Staphylococcus aureus (27.0%), Escherichia coli (14.0%) and Streptococcus pneumoniae (12.0%). Whilst most bacterial isolates displayed susceptibility (> 90%) to common antimicrobial agents, only 57.1% (8/14) of Escherichia coli isolates were susceptible to ampicillin and 58.3% (7/12) were susceptible to co-trimoxazole. Conclusions Gram-positive bacteria accounted for the majority of pediatric BSIs, of which invasive pneumococcal disease remains a noteworthy cause. The majority of isolates, except Escherichia coli, were susceptible to commonly used antimicrobials. This study confirms the knowledge of high rates of resistance of Escherichia coli to ampicillin. Therefore, empirical treatment should still include gentamicin. Monitoring of resistance patterns is warranted to ensure that antibiotic therapy remains appropriate. Keywords Bacteraemia · Infection · Pediatric · Resistance
Introduction The presence of viable bacteria in the bloodstream is a major problem for children because they may provoke a generalised inflammatory response in the body, or represent a serious infection in other specific sites. Inadequate treatment of bloodstream infections (BSI) may result in septic shock with multi-organ failure, or progression of infection at local sites, such as the lung, with severe local and generalized complications [1, 2]. Sepsis, defined as a systemic inflammatory response syndrome in the presence of suspected or proven infection [3], is a leading cause of morbidity and mortality in neonates and children worldwide [2, 4], reportedly responsible for * Poonam Mudgil [email protected] 1
School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
60–80% of an estimated 10 million childhood deaths each year [5, 6]. Antibiotic therapy and subsequent pathogen elimination is fu
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