title: Exploring the Epidemiology of Hospital-Acquired Bloodstream Infections in Children in England (January 2009-March 2010) by Linkage of National Hospital Admissions and Microbiological Databases.
abstract: BACKGROUND
  Hospital-acquired bloodstream infection (HA-BSI) requires immediate effective antibiotic treatment. However, there are no published national data for England that describe the pathogen profile and antibiotic resistance rates of HA-BSI in children.
  
  
  METHODS
  Probabilistic matching methods were used to link national data on microbiologically confirmed BSI to hospital in-patient admissions data for the period of January 2009-March 2010. HA-BSI was defined as a positive blood culture drawn from a child aged 1 month-18 years 2 or more days after admission (and before discharge).
  
  
  RESULTS
  A total of 8718 episodes of BSI was reported during the study period. Linkage allowed 82% of records to be matched, of which 23% (1734) were HA-BSI, giving a rate of 4.74 per 1000 admissions. The median age of infection was 1 year, and 54% of infections were in males. Methicillin resistance was seen in 83% and 17% of coagulase-negative staphylococci and Staphylococcus aureus, respectively. Penicillin resistance was rare in pyogenic streptococci but more common in viridans streptococci (39%). Among Gram-positive organisms, only 3% were vancomycin-resistant. The overall proportion of Gram-negative bacteria resistant to recommended empirical antibiotics (meropenem or piperacillin/tazobactam) was 5% and 16%, respectively, but <4% of isolates were resistant when either of these drugs were combined with gentamicin.
  
  
  CONCLUSIONS
  This study provides the first national estimates of the proportion of pediatric BSI that is hospital-acquired and describes the antimicrobial resistance of organisms causing infection. Pediatric HA-BSI remains unacceptably high; interventions must focus on identifying effective means of preventing HA-BSI, fostering antibiotic stewardship, and improving surveillance.
authors.affiliation: Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Blackburn
authors.affiliation: Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Henderson
authors.affiliation: Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Minaji
authors.affiliation: Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency.
authors.forename: Berit
authors.initials: B
authors.lastname: Muller-Pebody
authors.affiliation: Healthcare Associated Infection and Antimicrobial Resistance, Health Protection Agency.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Paediatric Infectious Diseases Research Unit, St George's Hospital, London, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
keywords: Antimicrobial Resistance; Bloodstream Infection; Nosocomial; Pediatric