Age-Stratified Clinical and Microbiological Profiles in Pediatric Infectious Disease Admissions: Implications for Risk Prediction and Antimicrobial Stewardship

Background/Objectives: Pediatric infectious-disease admissions are common but heterogeneous. We characterized clinical, microbiological, and therapeutic patterns and identified high-risk subgroups relevant to antimicrobial stewardship. Methods: In an observational cohort of 136 children stratified by age, we recorded symptoms, diagnoses, culture results, pathogens, antibiotic therapy, and outcomes. A composite risk score integrating age and clinical/microbiological parameters was assessed. Results: Outcomes were generally favorable: intensive care unit (ICU) transfer 8.8% (95% confidence interval [CI]: 4.6–15.1), mortality 0.7% (95% CI: 0.1–3.9), and median length of stay (LOS) 10 days (interquartile range [IQR] 8–12). Pneumonia was the leading diagnosis (44.9%; 95% CI: 36.3–53.6). Among isolates, Escherichia coli (47.1%) and Klebsiella species (spp.) (27.9%) predominated. Pneumonia correlated with prolonged LOS (p = 0.006), and gastroenteritis with ICU transfer (p = 0.038) and longer LOS (p = 0.018). Mixed E. coli + Klebsiella infections were linked to prolonged stay (p = 0.021). The composite score identified a high-risk stratum with higher ICU transfer (p = 0.004) and prolonged stay (p = 0.006). Conclusions: Although overall outcomes were favorable, risk was not uniform. An age-stratified, multifactorial assessment—integrating clinical presentation, microbiology, and a composite score—identified pediatric subgroups with worse prognoses, supporting targeted monitoring and stewardship-aligned, age-aware empiric therapy. External validation is warranted.