title: Targeted empiric antibiotic therapy for children with non-oncological comorbidities and community-onset invasive bacterial infections.
abstract: OBJECTIVE
  To describe the aetiology, risk factors, treatment and outcome of children with community-onset invasive bacterial infections (IBI) and determine the appropriateness of the nationally recommended empiric antibiotic therapy in children with non-oncological comorbidities.
  
  
  METHODS
  The CABIN network prospectively collected clinical information for all positive blood and cerebrospinal fluid cultures in children aged 1 month to 15 years in southwest London over three years.
  
  
  RESULTS
  During 2009-11, 119 healthy children each had a single IBI episode and 61 children with non-oncological comorbidities had 83 IBI episodes. The pathogens causing IBI in children with comorbidities and no central venous catheter (CVC) were similar to those causing IBI in healthy children. However, those with a CVC had multiple IBI episodes, often with pathogens usually associated with nosocomial infection. In particular, gastro-intestinal commensals were frequently responsible for IBI in TPN-dependent children with gastro-intestinal disease (16/43 episodes) and those with liver disease (8/43). Nationally recommended antibiotics were commenced empirically in 93%, with additional or alternate antibiotics more likely to be prescribed in children with comorbidities or those requiring intensive care. Fifteen children died (11 healthy, 4 with comorbidity), including 12 who died before arrival or in the Emergency Department.
  
  
  CONCLUSIONS
  Increasing care of children with comorbidities in the community has resulted in a significant proportion of community-onset IBI occurring in this group. Children with a CVC in situ - particularly those with gastro-intestinal and liver disease - were infected with a wider range of potentially more virulent pathogens. They might benefit from more broad-spectrum antimicrobial cover.
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Rosy
authors.initials: R
authors.lastname: Wells
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK; Centre for International Child Health, Imperial College, London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Le Doare
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Heath
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK; Immunisation Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK. Electronic address: shamez.ladhani@phe.gov.uk.
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000382:microbiology; D006801:Humans; D007157:Immunologic Surveillance; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000150:complications / Q000382:microbiology; D008131:London / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Central venous catheters; Comorbidity; Empiric antibiotics; Risk factors