Journal Article

Exploring the Epidemiology of Hospital-Acquired Bloodstream Infections in Children in England (January 2009–March 2010) by Linkage of National Hospital Admissions and Microbiological Databases

Ruth M. Blackburn, Katherine L. Henderson, Mehdi Minaji, Berit Muller-Pebody, Alan P. Johnson and Mike Sharland

in Journal of the Pediatric Infectious Diseases Society

Published on behalf of Pediatric Infectious Diseases Society

Volume 1, issue 4, pages 284-292
Published in print December 2012 | ISSN: 2048-7193
Published online October 2012 | e-ISSN: 2048-7207 | DOI: http://dx.doi.org/10.1093/jpids/pis084
Exploring the Epidemiology of Hospital-Acquired Bloodstream Infections in Children in England (January 2009–March 2010) by Linkage of National Hospital Admissions and Microbiological Databases

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Background.

Hospital-acquired bloodstream infection (HA-BSI) requires immediate effective antibiotic treatment. However, there are no published national data for England that describe the pathogen profile and antibiotic resistance rates of HA-BSI in children.

Methods.

Probabilistic matching methods were used to link national data on microbiologically confirmed BSI to hospital in-patient admissions data for the period of January 2009–March 2010. HA-BSI was defined as a positive blood culture drawn from a child aged 1 month–18 years 2 or more days after admission (and before discharge).

Results.

A total of 8718 episodes of BSI was reported during the study period. Linkage allowed 82% of records to be matched, of which 23% (1734) were HA-BSI, giving a rate of 4.74 per 1000 admissions. The median age of infection was 1 year, and 54% of infections were in males. Methicillin resistance was seen in 83% and 17% of coagulase-negative staphylococci and Staphylococcus aureus, respectively. Penicillin resistance was rare in pyogenic streptococci but more common in viridans streptococci (39%). Among Gram-positive organisms, only 3% were vancomycin-resistant. The overall proportion of Gram-negative bacteria resistant to recommended empirical antibiotics (meropenem or piperacillin/tazobactam) was 5% and 16%, respectively, but <4% of isolates were resistant when either of these drugs were combined with gentamicin.

Conclusions.

This study provides the first national estimates of the proportion of pediatric BSI that is hospital-acquired and describes the antimicrobial resistance of organisms causing infection. Pediatric HA-BSI remains unacceptably high; interventions must focus on identifying effective means of preventing HA-BSI, fostering antibiotic stewardship, and improving surveillance.

Keywords: Pediatric; Nosocomial; Bloodstream Infection; Antimicrobial Resistance

Journal Article.  4002 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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