Pediatric Bacteremia: Changing Etiology and Patterns of Antibiotic Resistance
Katherine Bakes, MD reviewing Irwin AD et al. Pediatrics 2015 Mar 9.
While vaccine-preventable bacteremia decreased after introduction of the pneumococcal vaccine in the U.K., gram-negative bacteremia and antibiotic resistance increased, particularly among children at risk for healthcare-associated infections.
In a retrospective analysis of children presenting to a pediatric emergency department (ED) in the U.K., investigators described changes in the etiology of bacteremia from 2001 to 2011 (pneumococcal vaccine was introduced in 2006). Bacteremia was considered healthcare-associated (HCA) in children with indwelling devices, primary or acquired immunodeficiency, regular hospital-based interventions (e.g., hemodialysis, intravenous therapies), or preterm birth and discharge from the neonatal unit within the past 12 months.
A total of 525 children (median age, 1.5 years) presented with 575 episodes of bacteremia. The rate of bacteremia was 1.4 per 1000 children; mortality was 5%. The most common organisms were Streptococcus pneumoniae (19%), Neisseria meningitidis (17%), and Staphylococcus aureus (15%); Escherichia coli and Group B Streptococcus were most common in young infants. During the study period, the rate per 1000 ED visits decreased for community-acquired bacteremia (0.93 to 0.57) and pneumococcal bacteremia (0.50 to 0.25), and increased for gram-negative bacteremia (0.24 to 0.53) and HCA bacteremia (0.17 to 0.43).
Children with HCA bacteremia were older than those with community-acquired bacteremia (median age, 2.3 vs. 1.4 years) and more likely to have gram-negative isolates (44% vs. 18%). Among children with indwelling central lines, the rate of HCA bacteremia increased from 3% to 22% over the study. Median time to antibiotics was 3 hours, and was 57 minutes longer for gram-negative infections than for vaccine-preventable infections. Only 1% of vaccine-preventable isolates were resistant to empiric therapy, versus 22% of gram-negative isolates. Length of stay, intensive care unit admission rate, and mortality did not change over time.
CITATION(S):
Irwin AD et al. Etiology of childhood bacteremia and timely antibiotics administration in the emergency department. Pediatrics 2015 Mar 9; [e-pub]
