[Bacteraemia in children in Iceland 1994-2005].

OBJECTIVE: Positive blood cultures from children suggest serious bloodstream infections. Quick medical response with targeted therapy is important, taking the child's age and medical history into account. Antibiotic therapy and vaccination programs must be based on accurate knowledge of the prevalence and antibiotic susceptibility of the bacteria. The aim of this study was to investigate epidemiological parameters associated with positive blood cultures in children in Iceland from September 20th 1994 to March 16th 2005.

MATERIALS AND METHODS: All positive bacterial blood cultures from children 0-18 years of age identified at the Department of Clinical Microbiology of the Landspitali University Hospital during the study period. Age and sex of the children, bacterial aetiology, date of collection and results of antimicrobial susceptibility tests were registered. The children were divided into four age groups: neonates (< or =30 days of age), infants (30 days to one year), preschool age (1-6 y) and school age (6-18 y). The blood cultures were classified as definite contamination, probable contamination, probable infection and definite infection.

RESULTS: During the study period 1253 positive blood cultures were obtained from 974 children; 647 from boys and 606 from girls. Most of the blood cultures were from children less than one year old (594; 47.4%) of which 252 were neonates (42.4% of all children <1 y of age). Coagulase negative staphylococci were the most commonly isolated organisms (37%). Of positive blood cultures considered definite infections Streptococcus pneumoniae was the most common (21.7%) followed by Staphylococcus aureus (19.8%) and Neisseria meningitidis (15.2%). N. meningitidis C was not isolated in children after a meningococcal C vaccination was launched in 2002. The most common pneumococcal serotypes/serogroups were 23, 6B, 7, 19 and 14. Macrolide resistance was common in pneumococci (19%) and group A haemolytic streptococci (33%).

CONCLUSION: The results provide important information for empirical antibiotical therapy and prophylactic measures such as vaccination. Increasing macrolide resistance limits their usefulness as empiric antibiotics in septic children. The results demonstrate the excellent efficacy of meningococcal C vaccination. Furthermore the results help in predicting the efficacy of pneumococcal vaccination of Icelandic children.