title: Bloodstream infections in children caused by carbapenem-resistant versus carbapenem-susceptible gram-negative microorganisms: Risk factors and outcome.
abstract: Carbapenems are often considered the last resort agents reserved for treatment of infections due to highly antimicrobial resistant organisms such as A. baumannii and P. aeruginosa. However, carbapenem-resistant Gram-negative (CRGN) pathogens have become much more prevalent in the last decade. The objective of this study was to determine risk factors for and outcome of bacteremia caused by Gram-negative microorganisms in a pediatric tertiary-care hospital. Among 97 patients with hospital-acquired Gram-negative bacteremia, 66 patients with carbapenem-susceptible Gram-negative pathogens (CSGN) were compared with the remaining 31 with CRGN isolates. The overall clinical response and microbiological response rates were 83.3% and 43.9% in CSGN group, and 54.8% and 32.3% in CRGN group, respectively (P=0.002 and P=0.004, respectively). The treatment failure and relapse rates were 18.2% and 6.1% in CSGN group, and 38.7% and 6.5% in CRGN group, respectively (P=0.03 in each). The infection-related mortality rates were 10.8% in the CSGN group and 32.3% in the CRGN group (P=0.01). The total length of stay in hospital before infection was longer in patients with CRGN bacteremia than that of the CSGN bacteremia (P=0.002). The extended spectrum antibiotic usage prior to infection was significantly different between the groups (P=0.008). Infections due to CRGN are generally associated with poorer patient outcomes. Longer hospital stay and extended spectrum antibiotic usage prior to infection are the most important risk factors for CRGN bacteremia in our cohort.
authors.affiliation: Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey. Electronic address: yas.oguz99@yahoo.com.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ozsurekci
authors.affiliation: Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Kubra
authors.initials: K
authors.lastname: Aykac
authors.affiliation: Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ali Bulent
authors.initials: AB
authors.lastname: Cengiz
authors.affiliation: Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Sevgen Tanır
authors.initials: ST
authors.lastname: Basaranoglu
authors.affiliation: Department of Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Sancak
authors.affiliation: Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Sevilay
authors.initials: S
authors.lastname: Karahan
authors.affiliation: Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ates
authors.initials: A
authors.lastname: Kara
authors.affiliation: Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ceyhan
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D015780:Carbapenems / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000378:metabolism; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Bacteremia; Children; Multi-drug resistance