title: Bloodstream Infections in Hospitalized Children: Epidemiology and Antimicrobial Susceptibilities.
abstract: BACKGROUND
  Bloodstream infection is a major cause of morbidity and mortality. Much of our understanding of the epidemiology and resistance patterns of bloodstream infections comes from studies of hospitalized adults.
  
  
  METHODS
  We evaluated the epidemiology and antimicrobial resistance of bloodstream infections occurring during an 11-year period in a large, tertiary care children's hospital in the US. All positive blood cultures were identified retrospectively from clinical microbiology laboratory records. We excluded repeat positive cultures with the same organism from the same patient within 30 days and polymicrobial infections.
  
  
  RESULTS
  We identified 8196 unique episodes of monomicrobial bacteremia in 5508 patients. Overall, 46% were community onset, 72% were Gram-positive bacteria, 22% Gram-negative bacteria and 5% Candida spp. Coagulase negative Staphylococcus was the most common isolated organism. ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) accounted for 20% of episodes. No S. aureus isolate was resistant to vancomycin or linezolid, and no increase in vancomycin minimum inhibitory concentration among methicillin-resistant S. aureus was observed during the study period. Clinically significant increases in vancomycin-resistant Enterococcus, ceftazidime-resistant P. aeruginosa or carbapenem-resistant Enterobacteriaceae were not observed during the study period; however, rates of methicillin-resistant S. aureus increased over time (P < 0.01).
  
  
  CONCLUSIONS
  Gram-positive and ESKAPE organisms are leading causes of bacteremia in hospitalized children. Although antimicrobial resistance patterns were favorable compared with prior reports of hospitalized adults, multicenter studies with continuous surveillance are needed to identify trends in the emergence of antimicrobial resistance in this setting.
authors.affiliation: From the *Division of Infectious Diseases, Center of Pediatric Clinical Effectiveness, †Health Care Analytics Unit, Center of Pediatric Clinical Effectiveness, ‡Pathology & Laboratory Medicine, The Children's Hospital of Philadelphia, Pennsylvania; §Department of Biostatistics and Epidemiology, and ¶Center for Clinical and Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Larru
authors.forename: Wu
authors.initials: W
authors.lastname: Gong
authors.forename: Neika
authors.initials: N
authors.lastname: Vendetti
authors.forename: Kaede V
authors.initials: KV
authors.lastname: Sullivan
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000935:Antifungal Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology*; D062606:Tertiary Care Centers; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents