title: Risk factors for mortality resulting from bloodstream infections in a pediatric intensive care unit.
abstract: BACKGROUND
  Bloodstream infections (BSIs) are prevalent in the critical care setting and have high attributable morbidity and mortality. The purpose of this study was to identify factors that significantly contribute to immediate as well as eventual mortality in patients with bloodstream infections at a pediatric intensive care unit (PICU).
  
  
  METHODS
  Retrospective review of 2097 clinical records from admissions to our PICU in a 2-year period. Two separate case-control models were used. In the first model, eventual mortality (EM CASES) reflected those patients with eventual mortality, and EM CONTROLS were those who survived. In the second, infection-related mortality (IRM) cases were those with infection-related mortality, defined as death within 7 days of BSI, and IRM CONTROLS were survivors past 7 days. Logistic regression was used to adjust for differences for 3 categories: patient characteristics, microbiology and treatment variables.
  
  
  RESULTS
  We identified 74 separate episodes of bacteremia. Having an underlying malignancy or immunodeficiency was the only independently significant predictor of eventual mortality for BSI isolated within the PICU. Patients with infection-related mortality more likely had Gram-negative bacteremia and/or fungemia, were older and had inadequate initial empiric antibiotic treatment at the time BSI was diagnosed.
  
  
  CONCLUSIONS
  Targeted and aggressive early interventions should guide the empiric treatment of BSIs, whereas prolonged broad spectrum treatment should be minimized to avoid the emergence of resistant pathogen organisms.
authors.affiliation: Department of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.forename: Jasjit
authors.initials: J
authors.lastname: Singh
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Arrieta
mesh_terms: D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000382:microbiology / Q000401:mortality*; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis