Objectives: Bloodstream infection (BSI) in children causes significant morbidity and mortality and is associated with longer hospital stays and higher healthcare costs. Our objective is to study the incidence and risk factors and identify causative organisms and outcomes of BSI among Omani children in a tertiary hospital.
Methods: A retrospective study of laboratory-confirmed BSI was conducted among children managed at Sultan Qaboos University Hospital, Oman, between 2014 and 2018. Patients’ demographic, clinical, and laboratory data were extracted from the hospital’s electronic records. Univariate and multivariate logistic regression analysis was used to explore the relationship between death within 30 days in children with confirmed BSI and the other studied factors.
Results: A total of 1253 positive blood cultures were identified during the study period. Among these, 592 were probable contaminants, representing 47.2% of positive blood cultures. Overall, 404 (32.2%) clinically significant episodes of BSI were identified in 272 patients. Two-thirds of the patients (346; 85.6%) were ≤ 5 years old. Overall, 5 years incidence of BSI was 13 per 1000 admission. Three-hundred thirty-three (82.4%) episodes were either hospital-onset or healthcare-associated. Comorbidities were present in 366 (90.6%) of these children including prematurity (106; 26.2%), hematological malignancies (90; 22.3%), gut-related pathologies (71; 17.6%), and metabolic/genetic syndromes (47; 11.6%). Of the significant isolates, 211 (52.2%) were gram-negative bacteria, 168 (41.6%) were gram-positive bacteria, and 25 (6.2%) were Candida species. Enterobacteriaceae (152; 37.6%) was the most common organism identified followed by Coagulase-negative staphylococci (63; 15.5%) and Staphylococcus aureus (47; 11.6%). Of the Klebsiella spp and Escherichia coli isolates, only 60% were susceptible to 3rd generation cephalosporins. Among the potential factors predisposing to BSI, the central venous catheter was the most frequent (182; 45%). The crude mortality at 30 days was 9.2%. Moreover, both Pediatric Intensive Care Units admission (COR = 2.24, 95% CI: 0.98-4.78) and the presence of Graft-Versus-Host Disease during bacteremia (COR = 7.99, 95% CI: 1.52-37.76) were associated with increasing death within 30 days.
Conclusions: We reported a high percentage of contaminants among our positive blood culture isolates, which highlighted an urgent need to follow aseptic precautions during blood culture collection. Since a large proportion of BSI was hospital related, there was an urge to optimize infection control strategies and Central Vein Access Device care. Adding gentamicin to the BSI empiric antimicrobial cover is highly recommended given the high rates of gram-negative organisms to third-generation cephalosporins.
Audience take away:
- A comprehensive understanding of the impact of BSI on the childhood population.
- Implementation of guidelines to improve the recognition and management of bacteremia.
- Providing insights about antimicrobial therapy and outcomes of BSI.