A 7-year study of bloodstream infections in an English children's hospital

Knowledge of the pattern of bloodstream infection (BSI) can help determine antibiotic prescribing policy and infection control procedures. Data on 2364 consecutive episodes of BSI at Birmingham Children's Hospital over 7 years were collected prospectively. A total of 1224 (51.8%) episodes were community-acquired, but only 281 (11.9%) were in previously healthy children. Intravascular devices (IVDs) were the most common source of infection, accounting for 48.9% of episodes. Gram-positive, gram-negative and anaerobic bacteria accounted for 66.2%, 31.3% and 0.4% of isolates, and 2.2% were yeasts. Coagulase-negative staphylococci, Staphylococcus aureus and enterococci accounted for over 50% of all isolates. Of these, only enterococci were predominantly hospital-acquired. Neisseria meningitidis was the most common cause of community-acquired BSI in previously healthy children. Of cases of meningococcaemia, 55.6% were diagnosed by PCR alone. Antibiotic resistance, especially in Enterobacteriaceae, S. aureus and enterococci, was more common than in earlier studies of BSI in children, and varied between specialties. The overall mortality rate directly attributable to infection was 2.4%, but was higher in neonates (6.2%) and in previously healthy children with community-acquired infections (5.3%). Conclusion:intravascular devices have emerged as the commonest source of bloodstream infection in children, leading to marked similarities in the species distribution of blood culture isolates across specialties other than General Paediatrics, and explaining the low overall mortality rate. Antibiotic resistance was found frequently in most commonly isolated pathogens, but differences between specialties suggest the existence of local risk factors, some of which might be amenable to infection control interventions.