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

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https://doi.org/10.1542/peds.2014-2061
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Etiology of childhood bacteremia and timely antibiotics administration in the emergency department. / Irwin, Adam D.; Drew, Richard J.; Marshall, Philippa et al.
In: BMC Pediatrics, Vol. 135, No. 4, 04.2015, p. 635-642.

Research output: Contribution to Journal/Magazine › Journal article › peer-review

Harvard

Irwin, AD, Drew, RJ, Marshall, P, Nguyen, K, Hoyle, E, Macfarlane, KA, Wong, HF, Mekonnen, E, Hicks, M, Steele, T, Gerrard, C, Hardiman, F, McNamara, PS, Diggle, PJ & Carrol, ED 2015, 'Etiology of childhood bacteremia and timely antibiotics administration in the emergency department', BMC Pediatrics, vol. 135, no. 4, pp. 635-642. https://doi.org/10.1542/peds.2014-2061

APA

Irwin, A. D., Drew, R. J., Marshall, P., Nguyen, K., Hoyle, E., Macfarlane, K. A., Wong, H. F., Mekonnen, E., Hicks, M., Steele, T., Gerrard, C., Hardiman, F., McNamara, P. S., Diggle, P. J., & Carrol, E. D. (2015). Etiology of childhood bacteremia and timely antibiotics administration in the emergency department. BMC Pediatrics, 135(4), 635-642. https://doi.org/10.1542/peds.2014-2061

Vancouver

Irwin AD, Drew RJ, Marshall P, Nguyen K, Hoyle E, Macfarlane KA et al. Etiology of childhood bacteremia and timely antibiotics administration in the emergency department. BMC Pediatrics. 2015 Apr;135(4):635-642. doi: 10.1542/peds.2014-2061

Author

Irwin, Adam D. ; Drew, Richard J. ; Marshall, Philippa et al. / Etiology of childhood bacteremia and timely antibiotics administration in the emergency department. In: BMC Pediatrics. 2015 ; Vol. 135, No. 4. pp. 635-642.

Bibtex

@article{09da52c3511445fe9c1390c3765f4df3,

title = "Etiology of childhood bacteremia and timely antibiotics administration in the emergency department",

abstract = "BACKGROUND: Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is 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 < .001). Health care-associated bacteremia was associated with an increased length of stay of 3.9 days (95% confidence interval: 2.3-5.8). Median time to antibiotics was 184 minutes (interquartile range: 63-331) and 57 (interquartile range: 27-97) minutes longer in Gram-negative bacteremia than in vaccine-preventable bacteremia.CONCLUSIONS: Changes in the etiology of pediatric bacteremia have implications for prompt, appropriate empirical treatment. Increasingly, pediatric bacteremia in the ED is health care associated, which increases length of inpatient stay. Prompt, effective antimicrobial administration requires new tools to improve recognition, in addition to continued etiological surveillance.",

keywords = "Anti-Bacterial Agents, Bacteremia, Child, Child, Preschool, Comorbidity, Early Medical Intervention, Emergency Service, Hospital, Female, Great Britain, Humans, Infant, Male, Microbial Sensitivity Tests, Neisseria meningitidis, Retrospective Studies, Risk Factors, Staphylococcus aureus, Streptococcus pneumoniae, Survival Analysis, Treatment Outcome",

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

note = "Copyright {\textcopyright} 2015 by the American Academy of Pediatrics.",

year = "2015",

month = apr,

doi = "10.1542/peds.2014-2061",

language = "English",

volume = "135",

pages = "635--642",

journal = "BMC Pediatrics",

issn = "1471-2431",

publisher = "BioMed Central",

number = "4",

}

RIS

TY - JOUR

T1 - Etiology of childhood bacteremia and timely antibiotics administration in the emergency department

AU - Irwin, Adam D.

AU - Drew, Richard J.

AU - Marshall, Philippa

AU - Nguyen, Kha

AU - Hoyle, Emily

AU - Macfarlane, Kate A.

AU - Wong, Hoying F.

AU - Mekonnen, Ellen

AU - Hicks, Matthew

AU - Steele, Tom

AU - Gerrard, Christine

AU - Hardiman, Fiona

AU - McNamara, Paul S.

AU - Diggle, Peter J.

AU - Carrol, Enitan D.

PY - 2015/4

Y1 - 2015/4

N2 - BACKGROUND: Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is 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 < .001). Health care-associated bacteremia was associated with an increased length of stay of 3.9 days (95% confidence interval: 2.3-5.8). Median time to antibiotics was 184 minutes (interquartile range: 63-331) and 57 (interquartile range: 27-97) minutes longer in Gram-negative bacteremia than in vaccine-preventable bacteremia.CONCLUSIONS: Changes in the etiology of pediatric bacteremia have implications for prompt, appropriate empirical treatment. Increasingly, pediatric bacteremia in the ED is health care associated, which increases length of inpatient stay. Prompt, effective antimicrobial administration requires new tools to improve recognition, in addition to continued etiological surveillance.

AB - BACKGROUND: Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is 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 < .001). Health care-associated bacteremia was associated with an increased length of stay of 3.9 days (95% confidence interval: 2.3-5.8). Median time to antibiotics was 184 minutes (interquartile range: 63-331) and 57 (interquartile range: 27-97) minutes longer in Gram-negative bacteremia than in vaccine-preventable bacteremia.CONCLUSIONS: Changes in the etiology of pediatric bacteremia have implications for prompt, appropriate empirical treatment. Increasingly, pediatric bacteremia in the ED is health care associated, which increases length of inpatient stay. Prompt, effective antimicrobial administration requires new tools to improve recognition, in addition to continued etiological surveillance.

KW - Anti-Bacterial Agents

KW - Bacteremia

KW - Child

KW - Child, Preschool

KW - Comorbidity

KW - Early Medical Intervention

KW - Emergency Service, Hospital

KW - Female

KW - Great Britain

KW - Humans

KW - Infant

KW - Male

KW - Microbial Sensitivity Tests

KW - Neisseria meningitidis

KW - Retrospective Studies

KW - Risk Factors

KW - Staphylococcus aureus

KW - Streptococcus pneumoniae

KW - Survival Analysis

KW - Treatment Outcome

U2 - 10.1542/peds.2014-2061

DO - 10.1542/peds.2014-2061

M3 - Journal article

C2 - 25755240

VL - 135

SP - 635

EP - 642

JO - BMC Pediatrics

JF - BMC Pediatrics

SN - 1471-2431

IS - 4

ER -

Research

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