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Multidrug-resistant Gram-negative Bacterial Bloodstream Infections in Children’s Hospitals in Japan, 2010–2017

Aizawa, Yuta MD, PhD*,†; Shoji, Takayo MD; Ito, Kenta MD§; Kasai, Masashi MD; Sakurai, Hiroki MD; Toyofuku, Etsushi MD**; Minami, Kisei MD††; Hoshino, Tadashi MD, PhD‡‡; Horikoshi, Yuho MD*

The Pediatric Infectious Disease Journal: July 2019 - Volume 38 - Issue 7 - p 653–659
doi: 10.1097/INF.0000000000002273
Original Studies
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Background: The risk factors of multidrug-resistant (MDR) Gram-negative bacilli (GNB) bloodstream infection (BSI) are not yet known in children. Our aim was to evaluate risk factors and outcomes associated with MDR GNB BSI in children.

Methods: Patients with GNB BSI were enrolled between April 2010 and March 2017 at 8 children’s hospitals in Japan. Clinical and microbiologic data were collected retrospectively. The risk factors and outcomes of MDR and non-MDR GNB BSI were compared.

Results: In total, 629 GNB BSI episodes met the case definition. The median age and proportion of males were 2 years (interquartile range, 0.3–8.7) and 50.7%, respectively. An underlying disease was found in 94% of patients. The proportion of BSI cases that developed >48 hours after admission was 76.2%. MDR comprised 24.5% of BSI cases. The MDR rate did not change over time (P = 0.540). The effective coverage rate of the initial empiric therapy for the MDR and non-MDR BSI cases was 60.4% and 83.4%, respectively (P < 0.001). The all-cause mortality rate at 28 days for all BSI, MDR-BSI and non-MDR BSI cases was 10.7%, 13.6% and 9.7%, respectively (P = 0.167). MDR BSI was independently associated with cancer chemotherapy within 30 days (odds ratio [OR] 43.90), older age (OR 1.05) and admission to the neonatal ward (OR 0.019).

Conclusions: One-fourth of GNB BSI cases were MDR. Cancer chemotherapy and older age were risk factors for MDR GNB BSI in children’s hospitals. MDR did not increase the all-cause mortality rate.

From the *Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

Division of Pediatric Infectious Diseases, Shizuoka Children’s Hospital, Shizuoka, Japan

§Division of General Pediatrics, Aichi Children’s Health and Medical Center, Aichi, Japan

Department of Infectious Disease Medicine, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan

Department of Rheumatics and Infectious Disease, Miyagi Children’s Hospital, Miyagi, Japan

**Department of Infectious Disease and Immunology, Kanagawa Children’s Medical Center, Kanagawa, Japan

††Department of General Pediatrics, Nagano Children’s Hospital, Nagano, Japan

‡‡Division of Infectious Diseases, Chiba Children’s Hospital, Chiba, Japan.

Accepted for publication December 7, 2018.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Yuta Aizawa, MD, PhD, Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children’s Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183–8561, Japan. E-mail: yaizawa@med.niigata-u.ac.jp.

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