title: Risk factors for mortality due to bacteremia and fungemia in childhood.
abstract: To define risk factors for mortality due to bacteremia and fungemia of childhood, 242 episodes (for which the mortality rate was 19%) were studied prospectively by univariate and multivariate analyses. The mortality rate was higher in neonates (23%) and in individuals 10-18 years old (26%) than in infants and young children (10%-16%). The mortality rate was 29% for children who had neutropenia, 29% for those who had received therapy with steroids, 26% for those who had received antibiotics, and 75% for those who were in septic shock. The fatality rates for polymicrobial bacteremia (40%), recurrent bacteremia (67%), and hospital-acquired bacteremia (28%) were higher than those for other types of bacteremia; the fatality rate was related to inappropriate empiric antibiotic treatment or to the specific organism isolated (mortality rates associated with the latter ranged from 0 to 60%). Seven variables that independently and significantly affected mortality were defined with use of multivariate logistic regression analysis: septic shock (odds ratio [OR], 26.4); polymicrobial (OR, 5.4), recurrent (OR, 4.5), or hospital-acquired (OR, 4.3) bacteremia; candidemia (OR, 3.6); inappropriate antibiotic treatment (OR, 2.4); and neutropenia (OR, 2.3). These variables should be considered for adequate management of bacteremic patients who are at high risk for death.
authors.affiliation: Department of Pediatrics, Beilinson Medical Center, Petah Tiqva, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Ashkenazi
authors.forename: L
authors.initials: L
authors.lastname: Leibovici
authors.forename: Z
authors.initials: Z
authors.lastname: Samra
authors.forename: H
authors.initials: H
authors.lastname: Konisberger
authors.forename: M
authors.initials: M
authors.lastname: Drucker
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000401:mortality; D016469:Fungemia / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D009503:Neutropenia / Q000150:complications; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications; D013256:Steroids / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D013256:Steroids