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Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate

BACKGROUND: Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. METHODS: We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hosp...

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Autores principales: Chisti, Mohammod Jobayer, Harris, Jason B, Carroll, Ryan W, Shahunja, K M, Shahid, Abu S M S B, Moschovis, Peter P, Schenkel, Sara R, Hasibur Rahman, Abu Sayem Mirza Md, Shahrin, Lubaba, Faruk, Tanveer, Kabir, Farhad, Ahmed, Dilruba, Ahmed, Tahmeed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280371/
https://www.ncbi.nlm.nih.gov/pubmed/34277885
http://dx.doi.org/10.1093/ofid/ofab260
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author Chisti, Mohammod Jobayer
Harris, Jason B
Carroll, Ryan W
Shahunja, K M
Shahid, Abu S M S B
Moschovis, Peter P
Schenkel, Sara R
Hasibur Rahman, Abu Sayem Mirza Md
Shahrin, Lubaba
Faruk, Tanveer
Kabir, Farhad
Ahmed, Dilruba
Ahmed, Tahmeed
author_facet Chisti, Mohammod Jobayer
Harris, Jason B
Carroll, Ryan W
Shahunja, K M
Shahid, Abu S M S B
Moschovis, Peter P
Schenkel, Sara R
Hasibur Rahman, Abu Sayem Mirza Md
Shahrin, Lubaba
Faruk, Tanveer
Kabir, Farhad
Ahmed, Dilruba
Ahmed, Tahmeed
author_sort Chisti, Mohammod Jobayer
collection PubMed
description BACKGROUND: Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. METHODS: We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. RESULTS: A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). CONCLUSIONS: Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed.
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spelling pubmed-82803712021-07-16 Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate Chisti, Mohammod Jobayer Harris, Jason B Carroll, Ryan W Shahunja, K M Shahid, Abu S M S B Moschovis, Peter P Schenkel, Sara R Hasibur Rahman, Abu Sayem Mirza Md Shahrin, Lubaba Faruk, Tanveer Kabir, Farhad Ahmed, Dilruba Ahmed, Tahmeed Open Forum Infect Dis Major Article BACKGROUND: Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. METHODS: We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. RESULTS: A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). CONCLUSIONS: Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed. Oxford University Press 2021-07-15 /pmc/articles/PMC8280371/ /pubmed/34277885 http://dx.doi.org/10.1093/ofid/ofab260 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Chisti, Mohammod Jobayer
Harris, Jason B
Carroll, Ryan W
Shahunja, K M
Shahid, Abu S M S B
Moschovis, Peter P
Schenkel, Sara R
Hasibur Rahman, Abu Sayem Mirza Md
Shahrin, Lubaba
Faruk, Tanveer
Kabir, Farhad
Ahmed, Dilruba
Ahmed, Tahmeed
Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate
title Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate
title_full Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate
title_fullStr Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate
title_full_unstemmed Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate
title_short Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate
title_sort antibiotic-resistant bacteremia in young children hospitalized with pneumonia in bangladesh is associated with a high mortality rate
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8280371/
https://www.ncbi.nlm.nih.gov/pubmed/34277885
http://dx.doi.org/10.1093/ofid/ofab260
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