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Carbapenem resistance and mortality in pediatric Acinetobacter bloodstream infections: determinants from a 12-year tertiary-care cohort study.

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Τίτλος: Carbapenem resistance and mortality in pediatric Acinetobacter bloodstream infections: determinants from a 12-year tertiary-care cohort study.
Συγγραφείς: Karauzum SE; Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Erci E; Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Koc G; Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Yazici Ozkaya P; Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Kiran Tasci E; Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Karakoyun M; Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Ozek G; Division of Pediatric Oncology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Ataseven E; Division of Pediatric Oncology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Terek D; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Yasar Duman M; Department of Medical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Cilli FF; Department of Medical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey., Sahbudak Bal Z; Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey., Avcu G; Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey. gul_akbas@yahoo.com.tr.
Πηγή: European journal of pediatrics [Eur J Pediatr] 2026 Oct 20; Vol. 185 (11). Date of Electronic Publication: 2026 Oct 20.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 7603873 Publication Model: Electronic Cited Medium: Internet ISSN: 1432-1076 (Electronic) Linking ISSN: 03406199 NLM ISO Abbreviation: Eur J Pediatr Subsets: MEDLINE
Imprint Name(s): Publication: Berlin : Springer Verlag
Original Publication: Berlin, New York, Springer-Verlag.
Ιατρικοί όροι (MeSH): Acinetobacter Infections*/mortality , Acinetobacter Infections*/drug therapy , Acinetobacter Infections*/microbiology , Carbapenems*/therapeutic use , Carbapenems*/pharmacology , Bacteremia*/mortality , Bacteremia*/drug therapy , Bacteremia*/microbiology , Anti-Bacterial Agents*/therapeutic use , Anti-Bacterial Agents*/pharmacology , Acinetobacter baumannii*/drug effects , beta-Lactam Resistance*, Humans ; Male ; Retrospective Studies ; Child, Preschool ; Child ; Infant ; Female ; Risk Factors ; Tertiary Care Centers ; Drug Resistance, Bacterial
Περίληψη: Carbapenem-resistant (CR) Acinetobacter spp. bloodstream infections (BSIs) are difficult to treat in children, yet pediatric data on factors associated with resistance and mortality remain limited. We aimed to identify factors associated with carbapenem resistance and 30-day mortality in pediatric Acinetobacter BSIs. We retrospectively analyzed children with monomicrobial Acinetobacter BSIs at a tertiary-care university hospital between January 2014 and September 2025. Factors associated with carbapenem resistance were assessed using co-primary logistic regression analyses in the full cohort and within A. baumannii; 30-day mortality was assessed using Cox regression. Among 128 episodes, median age was 2.0 years (IQR 0.76-8.01), 60.2% (77/128) were male and 90.6% (116/128) had comorbidities. Carbapenem resistance was identified in 54/128 episodes (42.2%), all caused by A. baumannii (54/87, 62.1%). Increasing age, longer hospitalization before BSI onset, mechanical ventilation (MV), and prior meropenem exposure were associated with resistance in both co-primary models. Adjusted ORs for MV were 23.77 (95% CI, 7.54-74.92) in the full cohort and 23.20 (95% CI, 5.39-99.95) within A. baumannii. Overall 30-day mortality was 13.3% (17/128) and was higher in CR than carbapenem-susceptible episodes (22.2% versus 6.8%; p = 0.011). Exploratory comparisons across CR A. baumannii treatment categories were inconclusive (exact p = 0.256). Thrombocytopenia (aHR, 6.12; 95% CI, 2.13-17.61) and carbapenem resistance (aHR, 3.01; 95% CI, 1.04-8.71) were associated with mortality in the primary Cox model.
Conclusion: Thrombocytopenia and carbapenem resistance were associated with 30-day all-cause mortality in the primary adjusted analysis; the resistance association was not statistically significant in A. baumannii-restricted and first-episode-only sensitivity analyses.
What Is Known: • Acinetobacter BSIs mainly affect medically complex hospitalized children. • Pediatric evidence on factors associated with carbapenem resistance and mortality remains scarce.
What Is New: • Increasing age, longer hospitalization before BSI onset, mechanical ventilation, and prior meropenem exposure were associated with carbapenem resistance in both the full Acinetobacter cohort and within A. baumannii. • Carbapenem resistance was associated with 30-day mortality in the primary model, but this finding was not consistently supported in sensitivity analyses; thrombocytopenia remained associated with mortality.
(© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Competing Interests: Declarations. Ethics approval: The study was approved by the Ege University Medical Research Ethics Committee (Decision No: 25-10 T/18; Date: October 2, 2025). The study was conducted in accordance with the Declaration of Helsinki and institutional regulations governing retrospective human research. Consent to participate: Written informed consent was obtained from the parents or legal guardians of all participants. Consent for publication: Not applicable. This manuscript does not contain any identifiable individual person’s data, images or videos. Competing interests: The authors declare no competing interests.
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Contributed Indexing: Keywords: Acinetobacter baumannii; Bloodstream infection; Carbapenem resistance; Children; Healthcare-associated infection; Mortality
Substance Nomenclature: 0 (Carbapenems)
0 (Anti-Bacterial Agents)
Entry Date(s): Date Created: 20261020 Date Completed: 20261020 Latest Revision: 20261020
Update Code: 20261020
DOI: 10.1007/s00431-026-07518-w
PMID: 42897394
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1432-1076
DOI:10.1007/s00431-026-07518-w