The burden of non-CLABSI hospital-onset bloodstream ınfections in pediatric wards outside the ıntensive care units.

BACKGROUND

Central line-associated bloodstream infections (CLABSIs) have been widely studied, but the burden of non-CLABSI hospital-onset bacteremia and candidemia (HOB/HOC) in children outside intensive care units (ICUs) remains poorly understood.

METHODS

We retrospectively analyzed pediatric patients (1 month-18 years) admitted to a tertiary referral hospital in Turkey between January 2021 and January 2025. Eligible cases included the first positive blood culture for a non-commensal organism on or after hospital day 4, without central venous catheters, peripherally inserted central catheters, or ICU stay. Demographic, clinical, microbiological, and outcome data were collected.

RESULTS

Of 14,985 blood cultures, 29 episodes of HOB/HOC met inclusion criteria. The median patient age was 38 months (IQR 11.5-78), with 65.5% under 5 years. The most frequent pathogens were Escherichia coli (17.2%), Staphylococcus aureus (17.2%), Coagulase-negative staphylococci (17.2%), Candida species (13.8%), and Klebsiella pneumoniae (13.8%). Clinical sources included skin/soft tissue infections, peripheral intravenous catheter thrombophlebitis, urinary, and respiratory infections. Patients with HOB/HOC stayed in the hospital a median of 11 extra days for infection treatment.

CONCLUSION

Non-CLABSI HOB/HOC significantly contribute to morbidity in pediatric wards, prolonging hospitalization and involving resistant pathogens. Infection prevention should extend beyond central lines to peripheral devices, supported by enhanced surveillance systems and definitions.

WHAT IS KNOWN: • Hospital onset bacteremia/candidemia are important healthcare-associated infections, with pediatric non-CLABSI cases largely understudied. • Existing literature offers limited epidemiologic and clinical data on non-ICU pediatric HOB/HOC.

WHAT IS NEW: • This study characterizes non-CLABSI pediatric HOB/HOC in general wards, predominantly affecting younger children. • The study demonstrates notable pathogen diversity with marked antimicrobial resistance and shows that these infections substantially extend hospitalization duration.