Epidemiology of Community-Acquired Versus Hospital-Acquired Bacteremia Among Infants up to 90-day-Old

Introduction: Community-acquired bacteremia(CAB) in young infants up to 90-day-old is distinct from hospital-acquired bacteremia(HAB). Our study aims to distinguish between CAB and HAB; to characterize the microbiology and the antibiotic susceptibility and to identify predicting factors for mortality in these groups.

Methods: The study included infants

Results: A total of 314 neonates, 325 episodes and 344 pathogens were identified. CAB comprised 43(15.2%) and HAB 282(84.8%) of the episodes. Meningitis was less common in the hospital compared to the community group, 4.6% vs 26.5% (p<0.001). E.coli(37.2%) and Group-B-streptococcus(30.2%) were predominant in CAB compared to Klebsiella spp.(23.9%) and Coagulase negative staphylococcus(33.9%) in HAB. Early-onset sepsis (<7-days) caused by Gram-negative (GN) pathogens demonstrated resistance to ampicillin-gentamicin or ampicillin-cefotaxime in 18.2% and 24.2% of cases respectively. Whereas GN isolates causing CAB were resistant to ampicillin-gentamicin in 8.3% and to ampicillin-cefotaxime in 12% of cases. Thirty-day mortality was reported in 18(5.7%) patients, all had HAB. Independent risk factors for 30-day mortality were Arabs, hemodynamic instability at time of bacteremia and Gram negative sepsis (p<0.0.028, <0.001, 0.043, OR 5.342, 38.482,10.251 respectively).

Conclusions: HAB differs absolutely from CAB in young infants. Significant rate of resistance to common antibiotic regimens was detected. Mortality is limited to HAB. Predictors of mortality are Arab ethnicity, hemodynamic instability and GN bacteremia.