Bloodstream Infections Caused by Carbapenem-Resistant Gram-negative Pathogens in Pediatric Critical Care Settings

INTRODUCTION: Infections and sepsis are the leading causes of death in non-cardiac ICUs and account for 40 percent of all ICU expenditures. Data regarding bloodstream infections (BSIs) due to a carbapenem-resistant gram negative (CRGN) microorganis in pediatric ICUs still remain limited.
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 bloodstream infection (BSI) caused by a carbapenem-resistant gram-negative microorganism and infections were assigned to BSI group other than BSI were assigned to non-BSI group.
RESULTS: This study included 96 critically ill children with a mean age of 48.6 (1-204) months.Requirement of invasive procedures included tracheostomy, foley catheter and central venous catheter were not statistically different among groups, P values were 0.159, 0.291 and 0.803, respectively. The majority of the patients admitted to PICU due to sepsis/septic shock in BSI group (n: 18, 58%) and in non-BSI group (n: 24, 37,9%). Prior third/fourth generation cephalosporin exposure significantly more common in BSI group (51.6% vs.15.5%, P<0.001), carbapenem exposure was not significantly different among groups (35.5% vs 56.9%, P=0.054). Neutropenia (<500/mm3) and thrombocytopenia (150x103/mm3) were more significantly more common in BSI group (P=0.011 and P=0.010) and C-reactive protein (CRP) level was significantly higher (P=0.018). Crude and attributable mortality did not show significance between groups, P values were 0.578 and 0.955, respectively.
DISCUSSION AND CONCLUSION: Carbapenem –resistant gram-negative infections are still major cause of morbiditity, mortality and healthcare associated infections. In this sudy, we evaluated the patients with BSI due to a CRGN microorganism and compared with other infection types. The risk factors and outcomes were similar except prior cephalosporin exposure. As a conclusion, we have to enhance the infection control programs and prevent the patients from redundant antibiotic exposure.