Clinical Characteristics of Carbapenem-Resistant Gram-Negative Bloodstream Infections and Fungemia Among High-Risk Pediatric Patients Receiving Empirical Antifungal Therapy

Background: Healthcare-associated bloodstream infections remain a significant cause of morbidity and mortality in hospitalized children, particularly in intensive care settings. Carbapenem-resistant Gram-negative bacterial (CR-GNB) bloodstream infections and fungemia may present with overlapping clinical features. This can complicate empirical treatment decisions in resource-limited settings. This study evaluated baseline clinical and laboratory characteristics associated with CR-GNB bloodstream infections and fungemia among high-risk pediatric patients. Methods: This retrospective observational cohort study included pediatric patients aged 0–18 years who were evaluated at the time of clinical deterioration and blood culture collection for suspected healthcare-associated bloodstream infection before empirical antifungal therapy initiation for the index episode. Patients who subsequently received empirical antifungal therapy between May 2023 and September 2025 were retrospectively screened. Of the 240 screened patients, 103 met the inclusion criteria and were classified into CR-GNB (n = 56) and fungemia (n = 47) groups based on blood culture results. Clinical, laboratory, and microbiological data were analyzed using univariate and multivariable statistical methods. Results: Observed 90-day all-cause mortality was higher in the CR-GNB group than in the fungemia group (50.0% vs. 29.8%, p = 0.038). Central venous catheter use was more frequent (91.1% vs. 48.9%, p = 0.006), and platelet counts were lower (median: 120 × 109/L vs. 259 × 109/L, p = 0.011) in patients with CR-GNB bloodstream infections. In multivariable analysis, thrombocytopenia (OR: 4.22, 95% CI: 1.35–13.17; p = 0.013) and central venous catheter use (OR: 5.53, 95%: CI 1.89–16.26; p = 0.002) were independently associated with CR-GNB bloodstream infections. The model showed moderate discrimination (AUC = 0.786). Conclusion: In this selected high-risk cohort, thrombocytopenia and central venous catheter use were associated with CR-GNB bloodstream infections. Observed mortality was higher in the CR-GNB group, but this finding should be interpreted with caution as adjusted mortality analysis and standardized severity assessment were not performed. These findings are hypothesis-generating and require validation in larger prospective studies before guiding empirical treatment decisions.