Community-acquired bloodstream infections in children > one month old in southern Israel (1992-2001): epidemiological, clinical and microbiological aspects.

We studied the epidemiology, microbiology, clinical picture and outcome of community-acquired bloodstream infections (CABI) in children in southern Israel during 1992-2001. Information was collected prospectively by daily surveillance. CABI was diagnosed when a positive blood culture was reported in a patient discharged from the emergency room or during <48 h since admission if hospitalized. There were 1439 CABI episodes in 1396 children aged 1 month to 14 y. CABI incidence was 100/100,000 children with no increase during the study period. Risk of CABI was 3.8 times higher in a Bedouin than in a Jewish child. 1561 bacteria (793, 50%, gram-positive and 768, 49% gram-negative organisms, respectively) and 13 fungi were recovered. Most frequent gram-positive organisms were Streptococcus pneumoniae (509 isolates, 32% of all isolates, 64% of all gram-positive), Staphylococcus aureus (137, 9%, 17%) and Streptococcus pyogenes (46, 3%, 6%). Enterobacteriaceae spp. were the most frequent gram-negative pathogens (279, 18%, 36%), followed by Brucella (205, 13%, 27%). S. pneumoniae was the most common pathogen in children <12 months and 1-5 y age; Brucella was the most frequent pathogen in children >5 y of age. Coverage of 7-valent pneumococcal conjugated vaccine for CABI was 38.5%. 38 (2.7%) patients died; 16 cases were caused by S. pneumoniae.

Nosocomial bloodstream infections in children and adolescents in southern Israel: a 10-year prospective study (1992-2001).

We studied the epidemiology, microbiology, clinical presentation and outcome of nosocomial bloodstream infections (NBI) in children and adolescents in southern Israel during 1992-2001. Information on NBI was collected prospectively by active surveillance. NBI was diagnosed when a clinically significant positive blood culture was drawn in a patient during >48 h after admission. 469 episodes occurred in 370 children and adolescents aged 1 m-18 y. The overall incidence of NBI was 5.3/1000 patients, with no increase during the study period. A significant decrease in NBI incidence was recorded at the neonatal intensive care unit (NICU) during 1997-2001 vs 1992-1996. The incidences of NBI at the paediatric ICU (PICU), paediatric wards and paediatric surgery departments (PSD) were 24.1, 2.8 and 2.5/1000 patients, with an increase in NBI cases at PICU and PSD during 1997-2001 vs 1992-1996. Of 661 pathogens, Gram-negative, Gram-positive and fungal organisms were isolated in 54.3%, 36.6% and 9.1% of cases, respectively. Enterobacteriaceae (34.6% of all isolates) were the most frequently isolated Gram-negative organisms. Enterococcus spp., coagulase-negative staphylococci and Staphylococcus aureus (9.5% of all isolates each) were the most frequently isolated in Gram-positive organisms. A significant increase was recorded in the incidence of NBI caused by Streptococcus pneumoniae and Pseudomonas spp. A significant decrease in the susceptibility of Enterobacteriaceae spp. to piperacillin, ceftazidime, gentamicin and ceftriaxone was recorded during the study period. 33 (8.9%) patients with NBI died.