Invasive Disease in Pediatric Population: 10 Year Review of a Level II Hospital

Background: Invasive pediatric disease (IPD) is a clinically compatible case confirmed by isolation of a microorganism from a normally sterile site. The incidence of infection due to multi-drug resistant (MDR) bacteria is increasing worldwide, which threatens the effective treatment of infections.

Objective: This study aims to characterize IPD in a Pediatric Department of a level II Lisbon hospital, namely its morbimortality, associated risk factors and antimicrobial susceptibility profile.

Methods: Descriptive retrospective study of IPD in children aged between 28 days and 18 years old, attended in our department from 2010 to 2020. Cases were identified by isolation of bacteria/fungi from a normally sterile site and medical records were reviewed to determine clinical data. Statistical analysis was performed using SPSS® Statistics23.

Results: 236 episodes of IPD were identified among 230 patients. At least one comorbidity was present in 25.4%, the most frequent being prematurity (37.7%) and sickle cell disease (30.4%). The median age was 21.4 month-old. Hospitalization was required in 206 episodes. The most common clinical presentation was bacteremia without a source (34%) followed by pneumonia (18%). Sepsis was observed in 17.4%. At the time of hospital discharge, 17.4% had at least one clinical sequela. The case fatality rate was 1.3%. In total, 279 microorganisms were isolated: 88% in blood, 6% in cerebrospinal fluid, 4% in pleural liquid and 2% in joint fluid. The most frequently isolated pathogens were Streptococcus pneumoniae (22.6%), followed by methicillin-susceptible Staphylococcus aureus (13.3%) and Escherichia coli (10.4%). We identified a total of 20.4% nosocomial infections and 7.5% MDR bacteria, the most frequent being Extended-spectrum β-lactamase-producing Enterobacteriaceae.

Conclusion: With this study we can confirm that IPD is still an important cause of morbidity and even mortality. The incidence of MDR microorganisms was almost 8%, which alerts to the problem of wide use of antibiotics, especially broad spectrum.