Thrombopenia and the nature of the microorganism in infected critically ill children

Background: Thrombopenia is correlated with sepsis and mortality in pediatric intensive care units. The purpose of this study was to find an association between thrombopenia and the microorganism type to guide the choice of empiric antibiotic therapy in infected critically ill children. Materials and methods: We conducted a prospective descriptive study, including all newborns, infants, and children admitted to a pediatric surgical intensive care unit from 1stJanuary to 31stDecember2009. We identified patients who developed an infection and/or thrombopenia (platelet count less than 100,000/mm3) during hospitalization. Results: One hundred ninety-seven patients were included (57newborns, 41infants, 99children). Ninety patients developed 100infectious episodes during the study period. Of the 57newborns enrolled in the study, 31(54%) developed 37infections. Seventy-six microorganisms (55Gram-negative bacilli [GNB], 17Gram-positive cocci, two Gram-negative cocci, two fungal pathogens) were identified during 65infectious episodes in 55patients. Thirty-four episodes of thrombopenia were observed in 30patients. Thrombopenia was observed only in infected patients (. P<. 0.001). Thrombopenia was associated with infections caused by GNB (26/28 vs 20/37, P= 0.001) and by Klebsiella (16/28 vs 6/37, P= 0.001) and may be associated with infections caused by GNB producing extended-spectrum beta-lactamases (. P= 0.07). Gram-positive cocci infections were correlated to the non-occurrence of thrombopenia (. P= 0.02). Postoperative peritonitis was also significantly associated with thrombopenia (. P= 0.03). The mortality rate in our patients was 12.7% (22.8% in neonates). There was an association between thrombopenia and death in univariate analysis (11/25 vs 19/172, P<. 0.001). Multivariate logistic regression analysis did not confirm thrombopenia as an independent predictive factor of mortality in children. Conclusion: Because of the relatively high proportion of resistantGNB, an empiric antibiotic therapy combining a carbapenem and an aminoglycoside may be indicated in infected critically ill children developing thrombopenia.