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Resistant gram-negative infections in a pediatric intensive care unit: a retrospective study in a tertiary care
Gürkan Atay1, Manolya Kara2, Murat Sütçü2
1Division of Pediatric Intensive Care, Department of Pediatrics, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Insights
Healthcare-associated infections in pediatric intensive care units are a significant concern. Extended drug resistance in Gram-negative infections was linked to higher mortality rates and a history of prior infection.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Healthcare-associated infections (HAIs) contribute to increased morbidity and mortality in intensive care units (ICUs).
- Understanding the characteristics of resistant Gram-negative infections is crucial for effective treatment strategies in pediatric ICUs.
Purpose of the Study:
- To compare multi-drug resistant (MDR) and extensively drug-resistant (XDR) infections.
- To evaluate the characteristics of Gram-negative bacterial infections in a pediatric intensive care unit (PICU).
Main Methods:
- Retrospective evaluation of pediatric patients with Gram-negative infections in a university hospital's PICU.
- Data collected between January 2011 and December 2015.
Main Results:
- The incidence of HAIs was 17.2%, with an incidence density of 32.7 per 1000 patient-days.
- Common pathogens included Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii.
- Extended drug resistance was associated with higher mortality and a history of Gram-negative infection.
Conclusions:
- HAIs pose a significant health problem in pediatric ICUs.
- Hospital colonization patterns should inform infection control strategies.
- Targeted interventions are needed to combat antimicrobial resistance in pediatric populations.
Aim:
Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital.
Material And Methods:
In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively.
Results:
One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1-205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance.
Conclusion:
Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.
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