Six-Year Surveillance of Pediatric Intensive Care Unit-acquired Bloodstream Infection and Predictors for Mortality

Background: Bloodstream infections (BSIs) contribute significantly to morbidity and mortality in pediatric intensive care units (PICUs). We describe the incidence and characteristics of BSI in children and identify factors associated with mortality.

Methods: The study included children aged up to 18 years who developed BSI during their stay in the PICU of a tertiary hospital during 2014-2019. Data on clinical presentation, laboratory measurements, causative agents and classification of BSI were collected retrospectively.

Results: The incidence of BSI was 47.12 per 1,000 PICU admissions and 7.95 per 1000 PICU hospitalization days. In 114 patients, 136 PICU-acquired BSIs were documented with 152 pathogens. Gram-negative rods (GNR) accounted for 75% of isolates, Gram-positive cocci (GPC) 21.7% and yeasts 3.3%. Klebsiella spp. were the predominant GNR and Staphylococcus aureus was the major GPC. About 50.9% of patients were younger than 1 year, compared with 29.1% of all patients admitted to the PICU during the study period (p<0.001). In 44.1% of cases, BSI was associated with a central venous catheter. ICU mortality was observed in 25 (21.9%) patients, compared to 94 (3.1%) patients without BSI (p<0.001). Hemodynamic instability (p=0.014, OR 4.098, CI 1.331-12.658) and higher BUN (p=0.044, OR 1.026, CI 1.001-1.051) were associated with increased ICU mortality. However, normal albumin levels were associated with lower ICU mortality (p=0.029, OR 0.386, CI 0.164-0.908).

Conclusion: Hemodynamic instability, elevated BUN, and low albumin levels were associated with ICU mortality. Improved management of dietary and hemodynamic status and intravascular fluid balance may lead to higher survival rates.