Avcu, GulhadiyeErci, EceBilen, Nimet MelisErsayoglu, IremOzek, GulcihanCeltik, UlgenTerek, DemetCilli, FerihaBal, Zumrut Sahbudak2025-04-112025-04-112024Avcu, G., Erci, E., Bilen, N. M., Ersayoglu, I., Ozek, G., Celtik, U., Terek, D., Cilli, F., & Bal, Z. S. (2025). Clinical outcomes and the impact of treatment modalities in children with carbapenem-resistant enterobacteriaceae bloodstream infections: A retrospective cohort study from a tertiary university hospital. Journal of Antimicrobial Chemotherapy, 80(1), 147-153.03057453https://doi.org/10.1093/jac/dkae387https://hdl.handle.net/11454/117055Background: The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections among children represents a significant global concern, leading to elevated mortality rates. The aim of this study was to evaluate the risk factors, outcomes, 30-day mortality rates and contributing factors in children with CRE bloodstream infections (CRE-BSIs). Methods: Data regarding demographic characteristics, treatment approaches and outcomes of hospitalized children aged 0-18 years diagnosed with CRE-BSIs between January 2018 and December 2022 were extracted from medical records. Mortality within 30 days of diagnosis and the predictive factors were analysed. Results: A total of 114 children, with a median age of 11 months (range: 6-69.5), were included. All cases of CRE-BSIs were either healthcare associated or hospital acquired and presented with at least one underlying comorbidity. A previous history of CRE colonization or infection rate was 48.2% (55/114). Klebsiella pneumoniae 87.7% (100/114) was the most frequently isolated microorganism, with a 30-day mortality rate of 14% (16/114). Multivariate analysis identified paediatric intensive care unit admission, invasive mechanical ventilation, inotropic support and thrombocytopenia due to CRE-BSIs as the most discriminative predictors for 30-day mortality (P < 0.001). Central venous catheter (CVC) removal was associated with a reduced mortality rate (P = 0.012). High-dose prolonged infusion of MEM-based or polymyxin-based antibiotic combinations did not impact survival. Lower MEM MIC values were associated with improved survival. Conclusions: The mortality rate of CRE-BSI is notably high in childhood. The use of antibiotic combination strategies did not demonstrate a significant impact on 30-day survival; however, the removal of CVCs was found to lower mortality rates.en10.1093/jac/dkae387info:eu-repo/semantics/closedAccessArticle801147153WOS:0013479569000012-s2.0-8521455200739475360Q1Q1