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Secular trends in pediatric bloodstream infections over a 20-year period at a tertiary care hospital in Germany

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Abstract

Objective

Over the last 20 years, a number of medical innovations with impact on the incidence of bacterial and fungal bloodstream infections (BSIs) in children have been developed and implemented. Although appropriate empirical antimicrobial therapy is a prerequisite to the successful treatment of BSIs, to date, epidemiological data on long-term microbiological trends in BSIs of hospitalized children have not been available.

Methods

Two cohorts of pediatric patients who were hospitalized in a single-center tertiary care hospital in Germany over a 20-year time span (period A from 1985 to 1995 vs. period B from 1997 to 2006) were retrospectively analyzed and compared with respect to the epidemiology and microbiology of BSIs.

Results

A total of 1,646 cases of monomicrobial BSIs were detected. The rate of positive blood culture results dropped from 4.5% in period A to 2.0% in period B. The proportion of gram-positive vs. gram-negative pathogens recovered from blood cultures remained stable. Among gram-positive pathogens, an increase in enterococci (3.3% vs. 8.2%) and in coagulase-negative staphylococci (CoNS) (22.9 vs. 28.2%) was observed. In contrast, BSIs caused by Staphylococcus aureus (16.4% vs. 11.7%), Streptococcus agalactiae (4.9% vs. 2.1%), Haemophilus influenzae (7.3% vs. 0.7%), and Neisseria meningitidis (1.9% vs. 0.5%) diminished. In analyzing subgroups, an increase of enterococcal and CoNS infections was noted among patients with immunosuppression and neonatal early-onset sepsis (EOS), while a decrease was found among late-onset sepsis (LOS) cases with S. viridans. Notably, aminopenicillin-resistant enterococci and aminopenicillin- and fluoroquinolone-resistant Enterobacteriaceae all increased over time, while the overall resistance pattern was still favorable. The overall mortality rate of BSIs decreased (5.2% vs. 2.6%).

Conclusions

Over the 20-year study period, the spectrum of specific microorganisms among BSIs shifted, with opportunistic pathogens becoming predominant. Despite an increase in the proportion of antibiotic-resistant organisms, however, the mortality rate decreased.

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Abbreviations

ALL:

Acute lymphoblastic leukemia

AML:

Acute myeloid leukemia

BSI:

Blood stream infection

CoNS:

Coagulase-negative staphylococci

CVC:

Central intravascular catheter

EOS:

Early-onset sepsis

ESBL:

Extended spectrum beta-lactamase

GBS:

Group B streptococci

Hib:

Haemophilus influenzae type B

JMML:

Juvenile monomyelocytic leukemia

LOS:

Late-onset sepsis

MCV:

Meningococcus C conjugate vaccine

MDS:

Myelodysplastic syndrome

NBSIs:

Nosocomial bloodstream infections

NICU:

Neonatal intensive care unit

n.a.:

Not available

n.d.:

Not determined

n.s.:

Non-significant

PICU:

Pediatric intensive care unit

PCV:

Pneumococcal conjugate vaccine

RR:

Relative risk

spp.:

Species

vs.:

Versus

95%-CI:

95% confidence interval

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Acknowledgments

The authors are grateful to Ursula Schmid, Käthe Brell, and Susanne Fukala for their excellent technical assistance.

Competing interests

The authors declare no conflict of interests.

Funding

P. Henneke was supported in part by grants from the Deutsche Forschungsgemeinschaft and the National Institutes of Health. M. Hufnagel was supported in part by an educational grant from the German Pediatric Infectious Disease Society.

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Correspondence to Markus Hufnagel.

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Hufnagel, M., Burger, A., Bartelt, S. et al. Secular trends in pediatric bloodstream infections over a 20-year period at a tertiary care hospital in Germany. Eur J Pediatr 167, 1149–1159 (2008). https://doi.org/10.1007/s00431-007-0651-4

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  • DOI: https://doi.org/10.1007/s00431-007-0651-4

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