Asian Pacific Journal of Tropical Medicine
Clinical outcomes and multidrug resistance patterns of rare Gram-negative bloodstream infections: An 8-year analysis from a tertiary pediatric hospital
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Abstract:
Objective: To evaluate the clinical characteristics, risk factors, antimicrobial susceptibility profiles, and outcomes of bloodstream infections caused by rare Gram-negative bacteria in a tertiary pediatric center. Methods: A retrospective analysis was conducted on pediatric patients (0-18 years) with rare Gram-negative bloodstream infections growth in blood cultures between 2016 and 2023. Common pathogens (Escherichia coli, Klebsiella pneumoniae, Pseudomonas spp., and Acinetobacter spp.) were excluded to focus on unusual isolates. Results: A total of 394 patients were included in the study. Their median age was 21.5 months and 237 (60.2%) were male. The cohort had a high prevalence of chronic underlying diseases (94.0%) and a median hospital stay of 27 (16, 49) days. Central venous catheters (35.8%) and recent blood product transfusions (35.8%) were the most frequent predisposing factors. The most prevalent isolates were Serratia spp. (20.1%), Stenotrophomonas maltophilia (17.5%), and Enterobacter spp. (15.2%). High rates of intrinsic and acquired resistance were observed: 100% of Serratia isolates were resistant to trimethoprim/sulfamethoxazole, and Elizabethkingia meningoseptica demonstrated extensive carbapenem resistance. Resistance to cotrimoxazole in Stenotrophomonas maltophilia was 0%. All-cause mortality was 13.7%, whereas infection-related mortality was 1.1%, specifically associated with Aeromonas spp. (10.0%), Comamonas testosteroni (25.0%), and Enterobacter spp (3.3%). Conclusions: Rare Gram-negative bacteria bloodstream infections in children represent a significant diagnostic and therapeutic challenge due to unpredictable resistance patterns. Our data suggest that empirical therapy for high-risk pediatric patients should be periodically reviewed to include coverage for these emerging pathogens, especially in those with indwelling devices and chronic comorbidities.
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