EC Paediatrics

Background: Pediatric sepsis and bloodstream infection require rapid empirical antimicrobial treatment, although the causative pathogen and antimicrobial susceptibility profile are usually unknown at emergency presentation. Gram-negative bacteria, including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii, are important causes of pediatric bloodstream infection, while extended-spectrum beta-lactamase production, carbapenem resistance, and multidrug resistance increasingly threaten first-line therapy. Evidence derived mainly from intensive care, oncology, neonatal, or mixed inpatient populations may not accurately represent children at the point of emergency care.

Objective: To estimate the prevalence and species distribution of Gram-negative bacteria and their antimicrobial resistance patterns among children with sepsis or bloodstream infection of emergency-care origin, and to identify factors associated with resistance and clinically important outcomes.

Methods: MEDLINE via PubMed, Embase, Scopus, Web of Science Core Collection, CINAHL, Global Index Medicus, and relevant gray-literature sources will be searched from 1 January 2010 to the final search date. No language or full-text-availability restriction will be applied. Eligible studies will include patients aged 0-18 years evaluated in an emergency department or meeting a prespecified emergency-origin classification based on blood-culture timing at or near hospital arrival. Two reviewers will independently screen records and assess risk of bias; extraction will use a standardized form with independent verification. Design-appropriate Joanna Briggs Institute tools will be used, with the Hoy tool restricted to a supplementary external-validity assessment for prevalence estimates. When at least three clinically and methodologically compatible studies are available, random-effects generalized linear mixed models with a logit link will be used to pool prevalence and pathogen-antibiotic resistance proportions. Denominator definitions, isolate-level and episode-level estimates, and explicit emergency-department recruitment versus inferred emergency origin will be analyzed separately. Heterogeneity will be explored by geography, age, infection acquisition, sepsis definition, host factors, laboratory standards, and study period.

Discussion: The review is designed to distinguish emergency-origin from hospital-acquired infection and to produce setting-specific evidence for empirical antibiotic selection, antimicrobial stewardship, surveillance, and future pediatric emergency medicine research.

Keywords: Pediatric Sepsis; Pediatric Emergency Department; Bloodstream Infection; Gram-Negative Bacteria; Antimicrobial Resistance; Multidrug Resistance; Prevalence; Systematic Review

Abbreviations

AMR: Antimicrobial Resistance; AST: Antimicrobial Susceptibility Testing; BSI: Bloodstream Infection; CLSI: Clinical and Laboratory Standards Institute; CRAB: Carbapenem-Resistant Acinetobacter baumannii; CRE: Carbapenem-Resistant Enterobacterales; CRPA: Carbapenem-Resistant Pseudomonas aeruginosa; DTR: Difficult-to-Treat Resistance; ESBL: Extended-Spectrum Beta-Lactamase; EUCAST: European Committee on Antimicrobial Susceptibility Testing; GLMM: Generalized Linear Mixed Model; GRADE: Grading of Recommendations Assessment, Development and Evaluation; MDR: Multidrug Resistant; PDR: Pandrug Resistant; PRESS: Peer Review of Electronic Search Strategies; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO: International Prospective Register of Systematic Reviews; XDR: Extensively Drug Resistant

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