A multicenter evaluation of Gram-negative bloodstream infections in children: predictors of carbapenem resistance

Abstract

Pediatric carbapenem-resistant Gram-negative (CRGN) infections cause high morbidity and mortality. Despite the rising global threat, multicenter data on resistance drivers in children remain limited. This study aimed to determine the prevalence, carbapenem resistance (CR) rates and clinical risk factors for Gram-negative bloodstream infections (GNBSIs) among hospitalized children in Turkey. Methods: A 1-month point prevalence study was conducted in November 2023 across 27 tertiary hospitals. Hospitalized patients (1 month–18 years) with laboratory-confirmed GNBSIs were included. Independent risk factors and prior antibiotic exposures were analyzed using regression models. Results: Among 15,249 patients, 180 GNBSIs were identified (prevalence: 1.19%). K. pneumoniae (28.3%), E. coli (12.7%) and P. aeruginosa (11.5%) were the most frequent pathogens. The overall CR rate was 33.3%, peaking at 73.6% in A. baumannii. Independent risk factors for CRGN BSIs included university hospital setting [adjusted odds ratio (aOR): 3.05; 95% confidence interval (CI): 1.47–6.31], central venous catheterization (aOR: 3.23; 95% CI: 1.10–9.40), mechanical ventilation (aOR: 2.59; 95% CI: 1.18–5.63) and steroid use (aOR: 2.59; 95% CI: 1.10–6.04). Prolonged antibiotic exposure (>7 days) to meropenem, colistin, glycopeptides and aminoglycosides significantly increased the odds of CR ( P Conclusions: This study highlights a high burden of CR in pediatric GNBSIs in Turkey. The identification of modifiable risk factors and the high prevalence of multidrug-resistant isolates emphasize the urgent need for enhanced infection control and robust antimicrobial stewardship programs.