To evaluate antimicrobial resistance patterns and factors associated with mortality in pediatric patients with Gram-negative bloodstream infections.
Approach:
Study Design: Retrospective cohort study of pediatric patients aged 0–18 years with laboratory-confirmed Gram-negative BSIs from January 2022 to September 2025.
Data Analysis: Analysis of demographic characteristics, invasive procedures, laboratory findings, antimicrobial susceptibility profiles, treatment-related variables, and clinical outcomes.
Mortality Factors: Evaluation of factors associated with all-cause in-hospital mortality using an exploratory multivariable logistic regression model.
Key Findings:
252 pediatric patients were included in the study.
Klebsiella spp. (46.4%) and Acinetobacter spp. (28.6%) were the most frequently isolated pathogens.
High resistance rates were observed for gentamicin (58.3%), ciprofloxacin (57.1%), imipenem (56.0%), and meropenem (48.4%).
Ceftazidime–avibactam resistance was significantly associated with study year (p = 0.008).
Overall all-cause in-hospital mortality rate was 31.7%.
Factors independently associated with mortality included central venous catheter use, thrombocytopenia, total parenteral nutrition, mechanical ventilation, and meropenem resistance.
Interpretation:
The study highlights significant antimicrobial resistance and high mortality rates in pediatric patients with Gram-negative BSIs.
Limitations:
The study did not perform molecular characterization of ceftazidime–avibactam resistance.
Data derived from a single tertiary care center may limit generalizability.
Conclusion:
Gram-negative BSIs in pediatric patients are associated with substantial antimicrobial resistance and considerable all-cause in-hospital mortality.
