Clinical and microbiological characteristics of bacteremia in pediatric intensive care unit: a retrospective analytical observational study.

PURPOSE: Children with bacteremia in the pediatric intensive care unit (PICU) are often in critical condition. Early recognition and treatment by clinicians are crucial to prevent the progression of bacteremia to fatal outcomes. METHODS: This single-center, retrospective analytical observational study included 9,814 pediatric patients in the PICU, ranging from 28 days to 18 years of age. Data were drawn from the pediatric intensive care (PIC) database between 2010 and 2018. Clinical characteristics, organisms isolated from blood cultures, drug resistance patterns, and factors associated with mortality were analyzed. RESULTS: Among the 9,814 patients, 630 (6.42%) had bacteremia, and 80 (12.70%) died during their hospital stay. Patients with bacteremia had lower levels of platelet (PLT) count, hemoglobin, potential of hydrogen (pH), arterial oxygen partial pressure (PaO2), sodium, and albumin, and higher levels of lactic dehydrogenase (LDH), alanine transaminase (ALT), activated partial thromboplastin time (APTT), prothrombin time (PT), D-dimer, C-reactive protein (CRP), and lactate (all P < 0.05). These patients also had increased hospital and ICU stays, along with higher in-hospital mortality compared to those without bacteremia. Age, APTT, CRP, and albumin were independent factors significantly associated with bacteremia in the PICU. A total of 728 pathogenic strains were isolated, including Gram-positive bacteria (70.05%), Gram-negative bacteria (23.90%), and fungi (6.04%). The highest case fatality rate (CFR) was observed in children with fungal septicemia (27.27%), followed by Gram-negative bacteremia (22.41%) and Gram-positive bacteremia (8.88%). The CFR was also higher in cases with multiple infections (20.34%) and multidrug-resistant (MDR) infections (14.43%). Multivariable logistic regression analysis revealed that PLT, APTT, and lactate were independent factors significantly associated with mortality in patients with bacteremia. CONCLUSIONS: Bacteremia in the PICU is associated with an increased mortality rate. Clinicians must identify and manage the risk factors associated with poor clinical prognosis early to improve the survival prospects of patients with bacteremia.