Pediatric bloodstream infections in metropolitan Australia
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.
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.
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.
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.
KeywordsBacteraemia Infection Pediatric Resistance
SMS contributed to data acquisition, data analysis and interpretation, and drafting of the manuscript. JW contributed to conception and design, data analysis and interpretation, and revision of the manuscript. PM contributed to obtaining of the ethics approval, data analysis and interpretation, revision of the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
This study was approved by Human Research Ethics Committee of South Western Sydney Local Health District.
Conflict of interest
No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
- 12.Bertrand X, Dowzicky MJ. Antimicrobial susceptibility among gram-negative isolates collected from intensive care units in North America, Europe, the Asia-Pacific Rim, Latin America, the Middle East, and Africa Between 2004 and 2009 as part of the Tigecycline Evaluation and Surveillance Trial. Clin Ther. 2012;34:124–37.CrossRefGoogle Scholar
- 15.Choffnes ER, Relman DA, Mack A. Antibiotic resistance: implications for global health and novel intervention strategies: workshop summary. Washington: National Academic Press; 2010.Google Scholar
- 17.Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011;52:285–92.CrossRefGoogle Scholar
- 22.National Safety and Quality Health Service Standards: Australian Commission on Safety and Quality in Health Care. 2012. Accessed 10 Oct 2018.Google Scholar
- 26.Er J, Wallis P, Maloney S, Norton R. Paediatric bacteraemias in tropical Australia. J Paediatr Child Health. 2015;51:437–42.Google Scholar
- 36.Allen UD, MacDonald N, Fuite L, Chan F, Stephens D. Risk factors for resistance to “first-line” antimicrobials among urinary tract isolates of Escherichia coli in children. Can Med Assoc J. 1999;160:1436–40.Google Scholar
- 37.Sepsis NEONATAL First Dose. Empirical Parenteral Antibiotic Guideline v2.1. 2013. Accessed 10 Oct 2018.Google Scholar
- 38.Sepsis PAEDIATRIC First Dose. Empirical Parenteral Antibiotic Guideline v2.1. 2013. Accessed 10 Oct 2018.Google Scholar
- 39.Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H, ARPEC project group. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016;71:1106–17.CrossRefGoogle Scholar
- 40.Aldeyab MA, Monnet DL, Lopez-Lozano JM, Hughes CM, Scott MG, Kearney MP, et al. Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: a time-series analysis. J Antimicrob Chemother. 2008;62:593–600.CrossRefGoogle Scholar
- 41.Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker JN. Antibiotic Use for Sepsis in Neonates and Children: 2016 Evidence Update. WHO Reviews. Accessed 16 Nov 2018.Google Scholar