TY - JOUR
T1 - A prospective study of gram-negative bacteremia in children
AU - Levy, Itzhak
AU - Leibovici, Leonaed
AU - Drucker, Moshe
AU - Samra, Zmira
AU - Konisberger, Hana
AU - Ashkenazi, Shai
PY - 1996
Y1 - 1996
N2 - Background. Hospital- and community-acquired Gram-negative bacteremia is a significant cause of mortality and morbidity in pediatric medical centers. Gram-negative organisms are isolated in >50% of pediatric patients with bacteremia. Objectives. To analyze clinical and epidemiologic variables associated with Gram-negative bacteremia in a tertiary children's medical center. Methods. A 6-year prospective study of children with Gram-negative bacteremia in a tertiary care children's medical center in Israel. Results. Three hundred seventy-four episodes of Gram-negative bacteremia were studied during 6 years. The predominant isolates were Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, which accounted for 109, 81 and 79 episodes (26, 20 and 19%), respectively. Of all episodes 43% occurred in neonates and infants younger than 2 years and 47% were hospital-acquired. Underlying conditions mainly acute leukemia and lymphoma, were present in 55% of the patients. Urinary tract infection followed by lower respiratory tract infection were the most common identified sources of bacteremia. Central intravenous catheters were associated with 53% of the episodes. The crude mortality was 11.4%. Increased mortality was significantly associated with acute leukemia, neutropenia, hospital-acquired infections and previous corticosteroid therapy (P = 0.03, 0.003, 0.006 and 0.01, respectively). Increased antibiotic resistance of hospital-acquired vs community-acquired isolates was noted; 44 to 77% resistance of nosocomial Klebsiella and Enterobacter sp. to second and third generation cephalosporins and 18% were resistant to amikacin. Conclusions. Klebsiella pneumoniae is currently the most common organism causing Gram-negative bacteremia in children. Because of the relatively high resistance of Gram-negative organisms to second and third generation cephalosporins, we suggest that empiric antibiotic therapy for Gram-negative bacteremia include a combination of an aminoglycoside and an anti-Pseudomonas beta-lactam.
AB - Background. Hospital- and community-acquired Gram-negative bacteremia is a significant cause of mortality and morbidity in pediatric medical centers. Gram-negative organisms are isolated in >50% of pediatric patients with bacteremia. Objectives. To analyze clinical and epidemiologic variables associated with Gram-negative bacteremia in a tertiary children's medical center. Methods. A 6-year prospective study of children with Gram-negative bacteremia in a tertiary care children's medical center in Israel. Results. Three hundred seventy-four episodes of Gram-negative bacteremia were studied during 6 years. The predominant isolates were Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, which accounted for 109, 81 and 79 episodes (26, 20 and 19%), respectively. Of all episodes 43% occurred in neonates and infants younger than 2 years and 47% were hospital-acquired. Underlying conditions mainly acute leukemia and lymphoma, were present in 55% of the patients. Urinary tract infection followed by lower respiratory tract infection were the most common identified sources of bacteremia. Central intravenous catheters were associated with 53% of the episodes. The crude mortality was 11.4%. Increased mortality was significantly associated with acute leukemia, neutropenia, hospital-acquired infections and previous corticosteroid therapy (P = 0.03, 0.003, 0.006 and 0.01, respectively). Increased antibiotic resistance of hospital-acquired vs community-acquired isolates was noted; 44 to 77% resistance of nosocomial Klebsiella and Enterobacter sp. to second and third generation cephalosporins and 18% were resistant to amikacin. Conclusions. Klebsiella pneumoniae is currently the most common organism causing Gram-negative bacteremia in children. Because of the relatively high resistance of Gram-negative organisms to second and third generation cephalosporins, we suggest that empiric antibiotic therapy for Gram-negative bacteremia include a combination of an aminoglycoside and an anti-Pseudomonas beta-lactam.
KW - Gram-negative bacteria
KW - antibiotic resistance
KW - bacteremia
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=0030024927&partnerID=8YFLogxK
U2 - 10.1097/00006454-199602000-00006
DO - 10.1097/00006454-199602000-00006
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C2 - 8822283
AN - SCOPUS:0030024927
SN - 0891-3668
VL - 15
SP - 117
EP - 122
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 2
ER -