Bacterial Bloodstream Infections in Pediatric Intensive Care Units: A Multicenter Cohort Study to Investigate the Epidemiology and Risk Factors for Mortality

BACKGROUND: Bloodstream infections (BSIs) are associated with a high mortality ratio among critically ill children. BSIs caused by multidrug-resistant (MDR) bacteria are a challenge due to limited therapeutic options. In this multicenter cohort study, factors associated with death of children with bacterial laboratory-confirmed BSI (LC-BSI) admitted to the intensive care unit (ICU) were analyzed, with a focus on MDR bacterial infection and appropriateness of therapy. METHODS: A prospective cohort of children aged ≤18 years with LC-BSI, and admitted to 9 ICUs, was conducted from January 1, 2016, to December 31, 2018, in Rio de Janeiro, Brazil. Risk factors of 30- and 7-day death of LC-BSI were identified using multivariable logistic regression analyses. RESULTS: Two hundred thirty-eight LC-BSI episodes occurred in 215 patients; 31.1% were caused by MDR bacteria. Inappropriate initial antibiotic therapy and definitive antibiotic therapy were administered in 50.4% and 8.4% of the episodes, respectively. The 30- and 7-day mortality ratios were 18.5% and 8.8%, respectively. Hematologic disease as primary condition, pediatric risk of mortality score ≥20 on date of LC-BSI, use of vasopressors, ICU-acquired BSI and LC-BSI from hospital B were independently associated with 30-day death. Inappropriate definitive antibiotic therapy; infectious disease, congenital heart disease and hematologic disease as primary conditions; PRISM score ≥20 at the time of LC-BSI; use of/vasopressors and LC-BSI secondary to respiratory tract or intra-abdominal infection were independently associated with 7-day death. CONCLUSIONS: Key clinical and healthcare-related factors associated with mortality in LC-BSI were identified.