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Factors that predict preexisting colonization with antibiotic-resistant gram-negative bacilli in patients admitted to
P Toltzis1, C Hoyen, S Spinner-Block
1Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Insights
Predicting antibiotic-resistant gram-negative rod colonization in pediatric ICU patients is possible. Prior ICU admissions and specific environmental factors predict colonization upon admission.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Antibiotic-resistant gram-negative rods pose a significant threat in pediatric intensive care units (ICUs).
- Early identification of colonization is crucial for implementing effective infection control measures.
Purpose of the Study:
- To predict which pediatric ICU patients are colonized with antibiotic-resistant gram-negative rods upon admission.
- To identify risk factors associated with colonization.
Main Methods:
- A prospective study of 727 children admitted to a pediatric ICU over 6 months.
- Collection of clinical and environmental data via parent questionnaires.
- Microbiological cultures (nasopharyngeal and rectal) and molecular analysis (pulsed field gel electrophoresis) to identify resistant organisms.
Main Results:
- Colonization with antibiotic-resistant gram-negative rods was identified in 8.8% of admissions.
- Predictive factors included a history of previous ICU admissions and recent intravenous antibiotic use.
- Environmental factors such as residence in a chronic care facility and household contact with a hospitalized individual were also associated with colonization.
Conclusions:
- A predictive profile for colonization with antibiotic-resistant gram-negative bacilli in pediatric ICU admissions can be established.
- Targeted infection control strategies are essential to manage the introduction and spread of these resistant bacteria within the ICU.
Objective:
To predict which patients hospitalized in a pediatric intensive care unit (ICU) are colonized with antibiotic-resistant gram-negative rods on admission.
Methods:
Consecutive children admitted to a pediatric ICU over a 6-month period were entered into the study. A questionnaire soliciting information regarding the child's medical history and home environment was completed by the parent or guardian. Nasopharyngeal and rectal cultures were obtained on each of the first 3 days of ICU admission, and organisms resistant to ceftazidime or tobramycin were identified. Only clonally distinct organisms, as confirmed by pulsed field gel electrophoresis, were analyzed. The association between identification of colonization with an antibiotic-resistant gram-negative rod within 3 days of ICU admission and factors included in the questionnaire was tested by chi2 or t test. RESULTS. In 64 (8.8%) of 727 admissions, an antibiotic-resistant gram-negative bacillus was isolated within the first 3 ICU days. More than half were identified on the day of admission. Colonization was associated with two factors related to the patient's medical history, namely, number of past ICU admissions (1.98 vs.87) and administration of intravenous antibiotics within the past 12 months (67.9% vs 28.2%). No association was found between colonization and exposure to oral antibiotics. In addition, factors related to the child's environment were also associated with presumed importation of an antibiotic-resistant gram-negative rod into the ICU. Specifically, residence in a chronic care facility was strongly associated with colonization (28.3% vs 2.6%); exposure to a household contact who had been hospitalized in the past 12 months also predicted colonization (41.7% vs 18.5%).
Conclusions:
These data suggest that a profile can be established characterizing children colonized with resistant gram-negative bacilli before admission to a pediatric ICU. Infection control measures may help to contain these potentially dangerous bacteria once they have been introduced into the unit.