title: Factors influencing antimicrobial resistance and outcome of Gram-negative bloodstream infections in children.
abstract: OBJECTIVE
  The aim of this study was to collect data about pediatric Gram-negative bloodstream infections (BSI) to determine the factors that influence multidrug resistance (MDR), clinical course and outcome of children affected by Gram-negative sepsis.
  
  
  METHODS
  In this observational, prospective, multicenter study we collected cases of pediatric Gram-negative BSI during a 2-year period. We analyzed epidemiological, microbiological and clinical factors that associated with acquisition of MDR infections and outcome.
  
  
  RESULTS
  One-hundred and thirty-five BSI episodes were analyzed. Median age of children was 0.5 years (IQR 0.1-6.17, range 0-17 years). Predominant bacteria were Enterobacteriaceae (68.3 %), and Pseudomonas spp. (17.9 %). Multidrug resistance was detected in 45/134 cases (33.6 %), with the highest rates in Escherichia coli, Enterobacter and Pseudomonas spp. Acquisition of MDR pathogens was significantly associated with prior cephalosporin treatment, older age, admission to hemato-oncology unit, polymicrobial infections, higher rate of development of septic shock, and multiple organ failures. All-cause mortality was 17.9 %. Presence of septic shock at presentation and parenteral nutrition were associated with higher mortality. Pseudomonas spp., and Enterobacter spp. BSIs had the highest rate of mortality. Inappropriate empiric antibiotic therapy was more frequent in MDR patients, although not significantly associated with poor outcome.
  
  
  CONCLUSIONS
  Rates of multidrug resistance and mortality in children with Gram-negative bloodstream infections remain high in our settings. Empiric broad-spectrum antibiotics and combination therapy could be recommended, especially in children with malignant diseases, patients admitted to the PICU, and for cases with septic shock, who have higher mortality risk.
authors.affiliation: Department of Anesthesiology and Intensive Care, Heim Pál Children's Hospital, Üllői út 86, Budapest, 1089, Hungary. ivadybalazs@yahoo.com.|Institute of Medical Microbiology, Semmelweis University of Budapest, Budapest, Hungary. ivadybalazs@yahoo.com.
authors.forename: Balázs
authors.initials: B
authors.lastname: Ivády
authors.affiliation: 1st Department of Pediatrics, Microbiology Laboratory, Semmelweis University of Budapest, Budapest, Hungary.
authors.forename: Éva
authors.initials: É
authors.lastname: Kenesei
authors.affiliation: 1st Department of Pediatrics, Semmelweis University of Budapest, Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Tóth-Heyn
authors.affiliation: 2nd Department of Pediatrics, Semmelweis University of Budapest, Budapest, Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Kertész
authors.affiliation: Bacteriology Laboratory, Egyesített Szent Isván and Szent László Hospital, Budapest, Hungary.
authors.forename: Klára
authors.initials: K
authors.lastname: Tárkányi
authors.affiliation: Department for Pediatric Haematology and Stem Cell Transplantation, Egyesített Szent Isván and Szent László Hospital, Budapest, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Kassa
authors.affiliation: Pediatric Intensive Care Unit, Egyesített Szent Isván and Szent László Hospital, Budapest, Hungary.
authors.forename: Enikő
authors.initials: E
authors.lastname: Ujhelyi
authors.affiliation: Department of Anesthesiology and Intensive Care, Bethesda Childrens Hospital, Budapest, Hungary.
authors.forename: Borbála
authors.initials: B
authors.lastname: Mikos
authors.affiliation: Center for Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Sápi
authors.affiliation: Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Varga-Heier
authors.affiliation: Department of Pediatrics, Szent György Hospital of County Fejér, Szekesfehervar, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Guóth
authors.affiliation: Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary.
authors.forename: Dóra
authors.initials: D
authors.lastname: Szabó
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bloodstream infection; Gram negative; Multidrug resistant; Outcome; Pediatric; Sepsis