title: Nosocomial bloodstream infections in Brazilian pediatric patients: microbiology, epidemiology, and clinical features.
abstract: BACKGROUND
  Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.
  
  
  METHODS
  We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).
  
  
  RESULTS
  In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.
  
  
  CONCLUSIONS
  In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
authors.affiliation: Instituto de Oncologia Pediatrica-IOP/GRAAC, Sao Paulo, Brazil.
authors.forename: Carlos Alberto Pires
authors.initials: CA
authors.lastname: Pereira
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Luis Fernando Aranha
authors.initials: LF
authors.lastname: Camargo
authors.forename: Antônio Carlos Campos
authors.initials: AC
authors.lastname: Pignatari
authors.forename: Teresa
authors.initials: T
authors.lastname: Sukiennik
authors.forename: Paulo Renato Petersen
authors.initials: PR
authors.lastname: Behar
authors.forename: Eduardo Alexandrino Servolo
authors.initials: EA
authors.lastname: Medeiros
authors.forename: Julival
authors.initials: J
authors.lastname: Ribeiro
authors.forename: Evelyne
authors.initials: E
authors.lastname: Girão
authors.forename: Luci
authors.initials: L
authors.lastname: Correa
authors.forename: Carla
authors.initials: C
authors.lastname: Guerra
authors.forename: Irna
authors.initials: I
authors.lastname: Carneiro
authors.forename: Carlos
authors.initials: C
authors.lastname: Brites
authors.forename: Marise
authors.initials: M
authors.lastname: Reis
authors.forename: Marta Antunes
authors.initials: MA
authors.lastname: de Souza
authors.forename: Regina
authors.initials: R
authors.lastname: Tranchesi
authors.forename: Cristina U
authors.initials: CU
authors.lastname: Barata
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000254:growth & development; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D062665:Epidemiological Monitoring; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007709:Klebsiella / Q000187:drug effects / Q000254:growth & development; D008297:Male; D013210:Staphylococcus / Q000187:drug effects / Q000254:growth & development; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents