Bloodstream infection tied to ICU admission, death in children hospitalized for flu

Bloodstream infections rarely occur in children hospitalized for influenza but are associated with intensive care unit (ICU) admission, mechanical ventilation, longer hospital stay, and higher in-hospital mortality, according to a study.

Consequently, these infections warrant greater levels of care among paediatric influenza hospitalizations, the authors said.

Out of 9,179 laboratory-confirmed influenza hospital admissions, 87 (0.9 percent) had a bloodstream infection. The most common pathogens were Streptococcus pyogenes (22 percent), Staphylococcus aureus (18 percent), and Streptococcus pneumoniae (17 percent).

Bloodstream infection occurred more frequently in children with cancer (adjusted odds ratio [aOR], 2.78, 95 percent confidence interval [CI], 1.23‒5.63), a laboratory-confirmed nonbloodstream bacterial infection (aOR, 14.1, 95 percent CI, 8.04‒24.3), or radiographically confirmed pneumonia (aOR, 1.87, 95 percent CI, 1.17‒2.97).

On the other hand, children with chronic lung disorders were less likely to acquire bloodstream infections (aOR, 0.41, 95 percent CI, 0.19‒0.80).

Disease severity markers such as ICU admission (aOR, 2.11, 95 percent CI, 1.27‒3.46), mechanical ventilation (aOR, 2.84, 95 percent CI, 1.63‒4.80), and longer hospital length of stay (aOR, 1.02, 95 percent CI, 1.01‒1.03) significantly correlated with bloodstream infection.

In addition, children with bloodstream infection had a higher risk of death (aOR, 13.0, 95 percent CI, 4.84‒29.1), following adjustment for age, influenza virus type, and the presence of any at-risk chronic complication.

In this study, the authors carried out an active surveillance for laboratory-confirmed influenza hospitalization among children aged ≤16 years at the 12 Canadian Immunization Monitoring Program Active hospitals, from the 2010–2011 to 2020–2021 influenza seasons. They also identified factors associated with bloodstream infection via multivariable logistic regression analyses.