Community- and hospital-acquired bacteremia and pattern of antibiotic resistance in children hospitalized with severe acute malnutrition.

Abstract

Objective: To determine the frequency of community- and hospital-acquired bacteremia and to evaluate the pattern of antibiotic resistance in children hospitalized with severe acute malnutrition (SAM). Study Design: Analytical, Cross-sectional study. Setting: Department of Pediatric Medicine, The National Institute of Child Health, Karachi, Pakistan. Period: February 2025 to July 2025. Methods: A total of 128 children aged 6 months to 5 years with SAM were enrolled using non-probability, consecutive sampling. Demographic details, clinical features, and anthropometric measurements were recorded. Necessary laboratory investigations and blood culture evaluations were performed. Data were analyzed in SPSS 26 using chi-square/Fisher’s exact test and Mann-Whitney U test, with p<0.05 as significant. Results: In 128 children, 71 (55.5%) were males, and the median age was 14.5 months (IQR 10.0–22.6). Bacteremia was identified in 19 (14.8%), of which 15 (78.9%) were community-acquired. Gram-negative organisms accounted for 57.9% of isolates, with E. coli (31.6%) and S. aureus (26.3%) most frequent. Gram-negative isolates accounted for 57.9%, with E. coli (31.6%), and Klebsiella pneumoniae (21.1%) showing high resistance to ampicillin and ceftriaxone. S. aureus isolates were universally susceptible to vancomycin and linezolid. Duration of fever>3 days was associated with bacteremia (OR 2.7; 95% CI 1.0–7.5; p=0.045). Mortality in children with SAM was 12.5% and strongly associated with bacteremia (OR 5.5; p=0.007). Conclusion: There is significant burden of bacteremia and the high prevalence of antimicrobial resistance among children with SAM.