High mortality among patients with positive blood cultures at a Childrens Hospital in Tbilisi, Georgia

Authors

  • Jami Schaffner Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
  • Sopio Chochua Department of Outpatient Services, Central Childrens Hospital, Tbilisi
  • Ekaterina V. Kourbatova Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
  • Maribel Barragan Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
  • Yun F. Wan Grady Memorial Hospital, Atlanta, GA
  • Henry M. Blumberg Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
  • Carlos Del Rio Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
  • H. Kenneth Walker Department of Medicine, Emory University School of Medicine,
  • Michael K. Leonard Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA

DOI:

https://doi.org/10.3855/jidc.123

Keywords:

blood infections, mortality, children

Abstract

Background: The etiology and outcomes of blood-stream infections (BSI) among paediatric patients is not well described in resource-limited countries including Georgia. Methodology: Patients with positive blood cultures at the largest paediatric hospital in the country of Georgia were identified by review of the medical and laboratory records of patients who had blood for cultures drawn between January 2004 and June 2006. Results: Of 1,693 blood cultures obtained during the study period, 338 (20%) were positive; of these, 299 were included in our analysis. The median age was 14 days from a range of 2 days to 14 years of which 178 (60%) were male; 53% of the patients with a positive culture were admitted to the Neonatal Intensive Care Unit (NICU). Gram-negative bacilli (GNB) represented 165 (55%) of 299 cultures. Further speciation of 135 (82%) of 165 Gram-negative rod (GNR) was not possible because of lack of laboratory capacity. Overall, mortality was 30% (90 of 299). Among the 90 children who died, 80 (89%) were neonates and 68 (76%) had BSI caused by Gram-negative organisms. In multivariate analysis, independent risk factors for in-hospital mortality included an age of less than 30 days (OR=4.00, 95% CI 1.89-8.46) and having a positive blood culture for a Gram-negative BSI (OR = 2.38, 95% CI 1.32-4.29). Conclusions: A high mortality rate was seen among children, particularly neonates, with positive blood cultures at the largest paediatric hospital in Georgia. Because of limited laboratory capacity, microbiological identification of common organisms known to cause BSI in children was not possible and susceptibility testing was not performed. Improving the infrastructure of diagnostic microbiology laboratories in countries with limited resources is critical in order to improve patient care and clinical outcomes, and from a public health standpoint, to improve surveillance activities.

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Published

2009-05-01

How to Cite

1.
Schaffner J, Chochua S, Kourbatova EV, Barragan M, Wan YF, Blumberg HM, Del Rio C, Walker HK, Leonard MK (2009) High mortality among patients with positive blood cultures at a Childrens Hospital in Tbilisi, Georgia. J Infect Dev Ctries 3:267–272. doi: 10.3855/jidc.123

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Section

Original Articles