Pediatric Gram-Negative Bacteremia: Hidden Agenda

Abstract

Background Recently, new types of community-onset bacteremia have been introduced as healthcare associated (HCA) in which the infection onset started outside the hospital and there were interactions with the healthcare system. Little data exist differentiating community-acquired (CA) and HCA bacteremia from hospital-acquired bacteremia (HA). Objectives This article determines differences in the epidemiological characteristics and bacteriology of community-onset (i.e., CA and HCA) and HA gram-negative bacteremia in Saudi pediatric patients. Methods We conducted a prospective cohort of all pediatric patients diagnosed with gram-negative bacteremia at the King Khalid University Hospital over a year (2015). We received daily electronic notifications of all blood culture positive cases for gram-negative bacilli. Results A total of 92 children were hospitalized with gram-negative bacteremia; among these 64 (71.1%) were with HA bacteremia, 20 (21.1%) with CA bacteremia, and 8 (7.8%) with HCA bacteremia. Urinary tract infection was common clinical presentation (50%) in the patients diagnosed with CA and HCA bacteremia. Up to 92% of HA bacteremia and 2% of CA bacteremia were presented with septic shock. The most common gram-negative bacteria causing bacteremia is Klebsiella pneumoniae, constituting almost 29.3% of all organisms, and was only isolated from HA bacteremia. The antimicrobial susceptibility among the 92 isolates showed that the organisms were nonextended spectrum β-lactamase (non-ESBL) in 90%, and 10% of the isolates were ESBL. There was a significant difference in the total frequency of isolates between CA and HA incidences, regardless of ESBL or non-ESBL (p < 0.001). Conclusion The most common type of gram-negative bacteremia is HA bacteremia followed by the CA and HCA bacteremia.