Beyond the First Infection: Exploring Recurrence in Pediatric Acinetobacter Cases

Background: Recurrent Acinetobacter infections (AIs) pose significant treatment challenges and contribute to an increased healthcare burden. Limited data exist on recurrent infections in pediatric patients, making it essential to better define their clinical and microbiological characteristics to guide effective management strategies. Methods: We retrospectively reviewed patients 0–18 years of age hospitalized between 2019 and 2024 with confirmed AI. Recurrent infection was defined as a new episode occurring within 90 days after clinical recovery and documented negative cultures. Clinical, microbiological and laboratory data, as well as treatment regimens and outcomes, were analyzed. Results: Among 150 pediatric patients with AI, the majority had underlying diseases (82.7%) and prolonged hospital stays exceeding 30 days (71.4%). Overall, 66.7% of isolates were multidrug- or extensively drug-resistant. Recurrent AI developed in 15.3% of patients, most frequently associated with port-catheter and bloodstream infections, and was significantly linked to longer hospitalization. Overall mortality was 34.7%, increasing to 47.8% in patients with recurrent AI. Independent risk factors for mortality included intensive care unit admission, the presence of multiple clinical findings, lymphopenia and hypocalcemia, while recurrent AI was independently associated with prolonged hospital stay. Conclusions: Recurrent AIs in pediatric patients impose a substantial clinical burden, being associated with both prolonged hospitalization and increased mortality. Identifying high-risk groups, particularly those with underlying diseases and critical illness, and ensuring closer monitoring with targeted management strategies are essential to improve clinical outcomes.