Clinical Report: Pediatric Gram-negative bloodstream infections and mortality

Overview

This study evaluates antimicrobial resistance patterns and mortality factors in pediatric patients with Gram-negative bloodstream infections (BSIs). The in-hospital mortality rate was reported at 31.7%.

Background

Gram-negative BSIs are a leading cause of morbidity and mortality in pediatric patients, especially in critically ill children. The rise of antimicrobial resistance complicates treatment options.

Data Highlights

Key Findings

• High resistance rates were observed for gentamicin (58.3%), ciprofloxacin (57.1%), imipenem (56.0%), and meropenem (48.4%).
• The overall all-cause in-hospital mortality rate was 31.7%.
• Prior meropenem exposure and antimicrobial treatment modification after blood culture collection were associated with higher mortality.
• Central venous catheter use (adjusted OR=13.58) was independently associated with mortality.
• Thrombocytopenia (adjusted OR=4.82) and total parenteral nutrition (adjusted OR=4.83) were also significant mortality factors.

Clinical Implications

The findings emphasize the need for continuous local surveillance and antimicrobial stewardship in pediatric populations. Understanding the factors associated with mortality can guide clinicians in managing high-risk patients more effectively.

Conclusion

The study presents challenges posed by antimicrobial resistance in pediatric Gram-negative BSIs and the associated high mortality rates.

Related Resources & Content

1. Infection — Clinical and Microbiological Characteristics of Gram-Negative Bloodstream Infections in Six University Hospitals in Germany (2016–2020)
2. Acta Paediatrica — Antimicrobial Resistance in Children With Bloodstream Infections: A Population-Based Study in Stockholm, Sweden
3. Infection — Factors Influencing Mortality in Pseudomonas aeruginosa Bacteraemia: The Impact of Infectious Diseases Consultation and Source Control in a Retrospective Cohort Analysis
4. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026
5. IDSA 2024 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections
6. Infection — Meropenem response in neonatal carbapenem-resistant Klebsiella pneumoniae: a narrative review of in vitro–in vivo discordance
7. Empirical Antibiotic Activity and Outcomes in Pediatric Gram-negative Bloodstream Infections
8. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026
9. IDSA 2024 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections
10. 30-d mortality risk factors in paediatric patients with bloodstream infection due to Enterobacterales: A retrospective observational cohort study - ScienceDirect
11. Frontiers | Risk factors associated with mortality and pathogen characteristics of bloodstream infection-induced severe sepsis in the pediatric intensive care unit: a retrospective cohort study
12. Ceftazidime/avibactam and ceftolozane/tazobactam for severe paediatric infections: A systematic review, meta-analysis, and evidence map - ScienceDirect
13. Multicenter Evaluation of Ceftazidime/Avibactam in Pediatric Patients Across the United States: Real-World Insights into the Management of Drug-Resistant Gram-Negative Infections - PMC