title: Epidemiology and outcome of Gram-negative bloodstream infection in children: a population-based study.
abstract: Population-based studies of Gram-negative bloodstream infection (BSI) in children are lacking. Therefore, we performed this population-based investigation in Olmsted County, Minnesota, to determine the incidence rate, site of acquisition, and outcome of Gram-negative BSI in children aged ⩽18 years. We used Kaplan-Meier method and Cox proportional hazard regression for mortality analysis. We identified 56 unique children with Gram-negative BSI during the past decade. The gender-adjusted incidence rate of Gram-negative BSI per 100 000 person-years was 129·7 [95% confidence interval (CI) 77·8-181·6]) in infants, with a sharp decline to 14·6 (95% CI 6·0-23·2) and 7·6 (95% CI 4·3-10·9) in children aged 1-4 and 5-18 years, respectively. The urinary tract was the most commonly identified source of infection (34%) and Escherichia coli was the most common pathogen isolated (38%). Over two-thirds (68%) of children had underlying medical conditions that predisposed to Gram-negative BSI. The overall 28-day and 1-year all-cause mortality rates were 11% (95% CI 3-18) and 18% (95% CI 8-28), respectively. Younger age and number of underlying medical conditions were associated with 28-day and 1-year mortality, respectively. Nosocomial or healthcare-associated acquisition was associated with both 28-day and 1-year mortality.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, KY 40536, USA. majdi.alhasan@uky.edu
authors.forename: M N
authors.initials: MN
authors.lastname: Al-Hasan
authors.forename: W C
authors.initials: WC
authors.lastname: Huskins
authors.forename: B D
authors.initials: BD
authors.lastname: Lahr
authors.forename: J E
authors.initials: JE
authors.lastname: Eckel-Passow
authors.forename: L M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008910:Minnesota; D016019:Survival Analysis; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology