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Pediatría (Asunción)

On-line version ISSN 1683-9803

Abstract

ARAYA, Soraya et al. Prognostic mortality factors in children with acquired bacteremia in the community (ABC) hospitalized at a tertiary medical center in Paraguay. Pediatr. (Asunción) [online]. 2018, vol.45, n.1, pp.17-24. ISSN 1683-9803.  https://doi.org/10.31698/ped.45012018003.

Objective:

To identify the etiology of ABC and prognostic factors of mortality.

Materials and Methods:

This was a retrospective study of ABC in patients aged 29 days to 16 years who were hospitalized at a Tertiary Medical Center in Paraguay, during the period from 2007 to 2015. We analyzed demographic, clinical and laboratory variables, categorizing the patients according to the outcome (Survival or Death).

Results:

We identified 187 cases of ABC, with an average age of 40 + 35 months, M / F ratio of 1.4: 1, age <1 year: 30.5% (57/187), 1 to 4 years 49.2% (92/187), 5 to 10 years 15.5% (29/187) and> 10 years 4.8% (9/187). The admission diagnoses were: Pneumonia (78%), Skin and Soft Tissue Infection (9%), Multiple Source Infection (7%), Meningitis (3.7%) and Bacteremia without a source 2%. Gram-positive bacteremia was more frequent than gram-negative bacteremia, 91.4 vs. 8.6% (p <0.05), isolates were: S.pneumoniae, S.aureus, S.coagulase negative (2/2) and K. pneumoniae (46%, 34%, 7.5% and 2%, respectively). 63 patients (33.7%) were admitted to the Intensive Care Unit (ICU), the mortality rate was 16.5%. Variables associated with mortality were: Age <5 years (p<0.05), Malnutrition (p = 0.02, RR = 2.4, 95% CI: 1.1-5), infection with multiple sources (p = 0.002, RR = 3.2, 95% CI: 1.6-6.4) ), Shock (p <0.001, RR = 19, 95%: 7.8-46), Glasgow coma scale score <12 (p <0.001, RR = 5.5, 95% 95% CI: 3.2-9.6), O2 Sat <94 % (p = 0.007, RR 2, 95% CI: 1.1-4), Hb <7 (p <0.01, RR: 11, 95% CI: 6.8 to 19), White Blood Cell count > 15000, platelets <100 000 (p<0.001, RR = 4.4, 95% CI: 2.4-7.8), Gram-positive bacteremia (p= 0.001, RR = 4.9, 95% CI: 1.5-15).

Conclusions:

Gram-positive bacteremia is more frequent in children with ABC. Prognostic factors of mortality were identified.

Keywords : Bacteremia; children; mortality.

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