Publication
Risk Factors for Bloodstream Infections in Critically Ill Children: Gram-Negative Predominance and Complex Chronic Conditions
Vicenzi V, Sousa I, Piva J · Acta Paediatrica, International Journal of Paediatrics · 2025
Aim: Bloodstream infections (BSIs) remain a significant cause of mortality in paediatric intensive care units (PICUs). This study aimed to identify risk factors associated with the aetiology and outcomes of hospital-acquired BSIs. Methods: This retrospective study analysed 422 blood cultures with pathogenic growth collected from patients admitted to a PICU in Brazil between 2018 and 2021. Data on underlying conditions, central venous catheter and PICU length of stay were obtained through medical record review. Logistic regression assessed the association between BSI aetiology and mortality. Results: A total of 148 BSIs were analysed in children with a median age of 33.5 months [IQR 5–110]; 60.0% were male. Gram-negative bacteria accounted for 43.2% of cases, Gram-positive for 41.2% and fungi for 15.5%. Carbapenem resistance was observed in 26.5% of Gram-negative isolates. Methicillin-resistant Staphylococcus aureus represented 40.0% of S. aureus. Gram-negative infections were associated with older age and oncohaematologic disease. Fungal infections were strongly associated with catheter use (OR 9.0; p = 0.039). Overall mortality was 24.3%. Vasoactive drug use was the only independent mortality predictor (RR 3.2; p = 0.004). Conclusions: Gram-negative bacteria predominated and were associated with oncohaematologic disease. Recognising risk factors may improve empirical treatment in critically ill children.
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