Methods: We performed a retrospective cohort study of children ≤19 years hospitalized in the critical care unit at the Children National Medical Center in Washington, DC with E. cloacae bloodstream infections between 2007 and 2016. We excluded polymicrobial infections. We performed chart review to collect baseline characteristics, treatment regimens, and outcomes. Recurrence of infection was defined as new E. cloacae bacteremia within 30 days of discontinuing antibiotics for initial infection.
Results: Twenty-six episodes of E. cloacae bacteremia met inclusion criteria. Median age was 7 months (IQR 2-16 mo), and 6/26 (23%) patients were African-American. All patients had at least one underlying chronic medical condition, the most common being neuromuscular (35%), end-stage renal disease (27%), oncologic (12%), and short bowel syndrome (15%). Central venous catheter was present in 18 (75%) patients and 10 (38%) had hemodynamic instability requiring vasopressor support at time of bacteremia. Seven isolates (27%) were not susceptible to third generation cephalosporins. Antibiotic treatment varied, with 7 (27%) receiving carbapenems empirically within 72 hours. Mean duration of bacteremia was 2.9 days. Infection recurred within 30 days in 2 patients (8%) and 2 patients (8%) died within 30 days of the initial positive blood culture.
Conclusion: All episodes of E. cloacae bacteremia occurring in children admitted to the ICU occurred in patients with underlying comorbid conditions, and more than half of affected children were infants < 1 year. More than one-third of these infections were associated with severe sepsis and nearly one in ten infected patients died within one month