title: Epidemiology and clinical outcomes of multidrug-resistant, gram-negative bloodstream infections in a European tertiary pediatric hospital during a 12-month period.
abstract: BACKGROUND
  Bloodstream infections caused by multidrug-resistant, Gram-negative (MDRGN) bacteria represent a significant cause of morbidity and mortality. Prompt diagnosis and appropriate empiric treatment are the most important determinants of patient outcome. The objective of our study was to assess the epidemiology and clinical outcome of MDRGN sepsis in a tertiary-care pediatric hospital during a 12-month period.
  
  
  METHODS
  It was a retrospective, observational study of MDRGN bacteremia including all patients <18 years of age, hospitalized during 2011, with documented bacteremia caused by Enterobacteriaceae or non-fermentative bacteria.
  
  
  RESULTS
  Overall, 136 blood cultures in 119 patients were included. The median age of patients was 1.1 years; 86.3% of patients had an underlying disease. The cumulative incidence of Gram-negative bloodstream infections was 5.4/1000 hospital admissions and the infection rate was 0.65/1000 hospital days. Most frequently isolated strains were Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa; 67.6% of infections were hospital acquired. The percentage of multidrug-resistant (MDR) organisms among isolated species was 39%. The crude rate of mortality was 16% and sepsis-related mortality was 9.2%. The mortality rate among patients with an antibiotic-resistant isolate was 22.6%. Factors significantly associated with sepsis-related mortality were antibiotic resistance (odds ratio: 4.26, 95% confidence interval: 1.07-16.9) and hospital acquisition of infection (odds ratio: 1.13, 95% confidence interval: 1.05-1.22).
  
  
  CONCLUSIONS
  This study demonstrates the high mortality of hospital-acquired MDRGN bacteremia in children. International networks focusing on clinical management and outcomes of MDRGN in children are required. Study of novel antibiotics active against Gram-negative bacteria should include children early in the clinical trial development programs.
authors.affiliation: From the *Department of Pediatrics (DPUO), University of Rome Tor Vergata; †Unit of Microbiology, Laboratory Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; ‡Paediatric Infectious Disease Research Group, Division of Clinical Sciences, St George's University of London, London, United Kingdom; §Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome; and ¶Clinical Microbiology Laboratory, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Folgori
authors.forename: Susanna
authors.initials: S
authors.lastname: Livadiotti
authors.forename: Michaela
authors.initials: M
authors.lastname: Carletti
authors.forename: Julia
authors.initials: J
authors.lastname: Bielicki
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pontrelli
authors.forename: Marta Luisa
authors.initials: ML
authors.lastname: Ciofi Degli Atti
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertaina
authors.forename: Barbara
authors.initials: B
authors.lastname: Lucignano
authors.forename: Stefania
authors.initials: S
authors.lastname: Ranno
authors.forename: Edoardo
authors.initials: E
authors.lastname: Carretto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muraca
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: Paola
authors.initials: P
authors.lastname: Bernaschi
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007711:Klebsiella pneumoniae; D007902:Length of Stay; D008297:Male; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012384:Rome / Q000453:epidemiology; D062606:Tertiary Care Centers