Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features

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Pires Pereira, Carlos Alberto ^[1] ; Marra, Alexandre R. ^{[2, 3]} ; Aranha Camargo, Luis Fernando ^{[2, 3]} ; Campos Pignatari, Antonio Carlos ^{[3, 4]} ; Sukiennik, Teresa ^[5] ; Petersen Behar, Paulo Renato ^[6] ; Servolo Medeiros, Eduardo Alexandrino ^[3] ; Ribeiro, Julival ^[7] ; Girao, Evelyne ^[8] ; Correa, Luci ^{[2, 9]} ; Guerra, Carla ^[10] ; Carneiro, Irna ; Brites, Carlos ^[11] ; Reis, Marise ^{[12, 13]} ; de Souza, Marta Antunes ^[14] ; Tranchesi, Regina ^[4] ; Barata, Cristina U. ^[15] ; Edmond, Michael B. ^[16] ; Grp, Brazilian SCOPE Study

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^[1] Inst Oncol Pediat IOP GRAAC, Sao Paulo - Brazil

^[2] Hosp Israelita Albert Einstein, Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo UNIFESP, Sao Paulo - Brazil

^[4] Hosp 9 Julho, Sao Paulo - Brazil

^[5] Santa Casa Porto Alegre, Porto Alegre, RS - Brazil

^[6] Hosp Conceicao, Porto Alegre, RS - Brazil

^[7] Hosp Base, Brasilia, DF - Brazil

^[8] Hosp Walter Cantidio, Fortaleza, Ceara - Brazil

^[9] Hosp Rim & Hipertensao, Sao Paulo - Brazil

^[10] Hosp Diadema, Sao Paulo - Brazil

^[11] Hosp Espanhol, Salvador, BA - Brazil

^[12] Hosp Coracao, Natal, RN - Brazil

^[13] Hosp UNIMED, Natal, RN - Brazil

^[14] Hosp Clin Goiania, Goiania, Go - Brazil

^[15] Univ Fed Triangulo Mineiro, Uberaba, MG - Brazil

^[16] Virginia Commonwealth Univ, Richmond, VA - USA

• Tipo de documento: Artigo Científico
• Fonte: PLoS One; v. 8, n. 7 JUL 4 2013.
• Citações Web of Science: 31

Resumo

Background: Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. Methods: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (<= 16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). Results: In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (<= 16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. Conclusions: In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients. (AU)

• Processo FAPESP: 06/57700-0 - Projeto brazilian scope (surveillance and control of pathogens of epidemiological importance).
• Beneficiário: Antonio Carlos Campos Pignatari
• Modalidade de apoio: Auxílio à Pesquisa - Regular