Epidemiology of and risk factors for Acinetobacter species bloodstream infection in children

Background: Acinetobacter species has emerged as an important cause of healthcare-associated bloodstream infections (BSI) in adults. Little is known about development of Acinetobacter spp. BSI in children. Methods: A retrospective case-control study was conducted at a tertiary care children's hospital between January 1, 2000 and July 31, 2005. All patients with Acinetobacter spp. BSI (N = 92) were compared with a random sample of patients with non-Acinetobacter spp. Gram-negative rod BSI (N = 156). Results: Acinetobacter spp. were isolated from blood cultures in 7% of the 1269 patients with Gram-negative rod BSI during the study period. The median age of patients with Acinetobacter spp. BSI was 5.4 years (interquartile range 1.8-13.2 years) and 57% were male. Antibiotic susceptibility patterns of Acinetobacter spp. isolates varied by class: 47% were nonsusceptible to cefotaxime; 3% were nonsusceptible to imipenem; 3% were nonsusceptible to ciprofloxacin. On multivariable analysis, patients with Acinetobacter spp. BSI were significantly more likely to develop their infection in the home setting [adjusted odds ratio (OR) = 3.58; 95% confidence interval (Cl): 1.89-6.79], to be male (adjusted OR = 2.25; 95% Cl: 1.24-4.08), to have a solid malignancy (adjusted OR = 4.23; 95% Cl: 2.00-8.95), and to have renal failure (adjusted OR = 5.16; 95% Cl: 1.07-24.96). Conclusions: Acinetobacter spp. are an underreported cause of endemic BSI in children. Patients with Acinetobacter spp. BSI are more likely to develop their infection in the home setting compared with patients with BSI caused by other Gram-negative rods.