{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:36Z","timestamp":1784527416784,"version":"3.55.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gram-negative bloodstream infections (BSIs) are associated with substantial morbidity and mortality in pediatric patients, particularly among critically ill children. Increasing antimicrobial resistance among Gram-negative pathogens has further complicated empirical treatment strategies and limited therapeutic options. This study aimed to evaluate antimicrobial resistance patterns and factors associated with mortality in pediatric patients with Gram-negative BSIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included pediatric patients aged 0\u201318 years with laboratory-confirmed Gram-negative BSIs diagnosed between January 2022 and September 2025 at a tertiary care center. Demographic characteristics, invasive procedures, laboratory findings, antimicrobial susceptibility profiles, treatment-related variables, and clinical outcomes were analyzed. Factors associated with all-cause in-hospital mortality were evaluated using an exploratory multivariable logistic regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 252 pediatric patients were included. Klebsiella spp. (46.4%) and Acinetobacter spp. (28.6%) were the most frequently isolated pathogens. High resistance rates were observed for gentamicin (58.3%), ciprofloxacin (57.1%), imipenem (56.0%), and meropenem (48.4%). Ceftazidime\u2013avibactam resistance was significantly associated with study year (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). The overall all-cause in-hospital mortality rate was 31.7%. Prior meropenem exposure and antimicrobial treatment modification after blood culture collection were associated with higher mortality. In the revised multivariable model, central venous catheter use (adjusted OR=13.58, 95% CI: 5.02\u201336.60), thrombocytopenia (adjusted OR=4.82, 95% CI: 2.10\u201311.02), total parenteral nutrition (adjusted OR=4.83, 95% CI: 2.09\u201311.13), mechanical ventilation (adjusted OR=3.74, 95% CI: 1.41\u20139.97), and meropenem resistance (adjusted OR=3.00, 95% CI: 1.28\u20137.03) were independently associated with mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gram-negative BSIs in pediatric patients were associated with substantial antimicrobial resistance and considerable all-cause in-hospital mortality. The increase in ceftazidime\u2013avibactam resistance should be interpreted cautiously because molecular characterization was not performed. Continuous local surveillance, antimicrobial stewardship, and infection prevention strategies are important, particularly in high-risk neonatal and pediatric intensive care populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1893910","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:34:39Z","timestamp":1784525679000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gram-negative bloodstream infections in pediatric patients: antimicrobial resistance and factors associated with mortality"],"prefix":"10.3389","volume":"14","author":[{"given":"Asuman","family":"Akar","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Infectious Diseases, Dicle University Faculty of Medicine","place":["Diyarbak\u0131r, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Pi\u015firici","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Dicle University Faculty of Medicine","place":["Diyarbak\u0131r, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","year":"2022","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/S0140-6736(10)61458-4","article-title":"Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis","volume":"377","author":"Allegranzi","year":"2011","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1097\/QCO.0000000000000371","article-title":"Antimicrobial-resistant gram-negative infections in neonates: burden of disease and challenges in treatment","volume":"30","author":"Folgori","year":"2017","journal-title":"Curr Opin Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S28","DOI":"10.1093\/infdis\/jiw282","article-title":"The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace","volume":"215","author":"Logan","year":"2017","journal-title":"J Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1126\/science.aaf9286","article-title":"Achieving global targets for antimicrobial resistance","volume":"353","author":"Laxminarayan","year":"2016","journal-title":"Science"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1699987","DOI":"10.3389\/fphar.2026.1699987","article-title":"The WHO priority list of antibiotic-resistant bacteria: challenges and opportunities for next-generation antimicrobial development","volume":"17","author":"Abdallah","year":"2026","journal-title":"Front Pharmacol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1097\/QCO.0000000000000627","article-title":"New treatment options for multiresistant gram negatives","volume":"33","author":"Paterson","year":"2020","journal-title":"Curr Opin Infect Dis"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae403","article-title":"Infectious Diseases Society of America 2024 Guidance on the treatment of antimicrobial-resistant gram-negative infections","author":"Tamma","year":"2024","journal-title":"Clin Infect Dis"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e18969","DOI":"10.1016\/j.heliyon.2023.e18969","article-title":"Carbapenem-resistant gram-negative bacterial prevention practice in nosocomial infection and molecular epidemiological characteristics in a pediatric intensive care unit","volume":"9","author":"Yin","year":"2023","journal-title":"Heliyon"},{"key":"B10","doi-asserted-by":"publisher","first-page":"69","DOI":"10.3390\/pathogens8020069","article-title":"Infections with carbapenem-resistant gram-negative Bacteria are a serious problem among critically ill children: a single-centre retrospective study","volume":"8","author":"Aygun","year":"2019","journal-title":"Pathogens"},{"key":"B11","doi-asserted-by":"publisher","first-page":"286","DOI":"10.5897\/AJMR2021.9497","article-title":"Molecular characterization of carbapenem resistant gram-negative rods in neonatal intensive care unit of Mansoura University Children\u2019s Hospital","volume":"15","author":"Heba","year":"2021","journal-title":"Afr. 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