Etiology of childhood bacteremia and timely antibiotics administration in the emergency department

Adam D. Irwin, Richard J. Drew, Philippa Marshall, Kha Nguyen, Emily Hoyle, Kate A. Macfarlane, Hoying F. Wong, Ellen Mekonnen, Matthew Hicks, Tom Steele, Christine Gerrard, Fiona Hardiman, Paul S. McNamara, Peter J. Diggle, Enitan D. Carrol

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is abstract associated with significant morbidity and mortality. Its evolving etiology may affect the ability of clinicians to initiate timely, appropriate antimicrobial therapy. METHODS: A retrospective time series analysis of bacteremia was conducted in the Alder Hey Children's Hospital ED between 2001 and 2011. Data on significant comorbidities, time to empirical therapy, and antibiotic susceptibility were recorded. RESULTS: A total of 575 clinical episodes were identified, and Streptococcus pneumoniae (n = 109), Neisseria meningitidis (n = 96), and Staphylococcus aureus (n = 89) were commonly isolated. The rate of bacteremia was 1.42 per 1000 ED attendances (95% confidence interval: 1.31-1.53). There was an annual reduction of 10.6% (6.6%-14.5%) in vaccine-preventable infections, and an annual increase of 6.7% (1.2%-12.5%) in Gram-negative infections. The pneumococcal conjugate vaccine was associated with a 49% (32%-74%) reduction in pneumococcal bacteremia. The rate of health care-associated bacteremia increased from 0.17 to 0.43 per 1000 ED attendances (P =.002). Susceptibility to empirical antibiotics was reduced (96.3%-82.6%; P

Original languageEnglish (US)
Pages (from-to)635-642
Number of pages8
JournalPediatrics
Volume135
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

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