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Published on: February 9, 2011
Device-associated multidrug-resistant bacteria surveillance in critically ill children: 10 years of experience
Mònica Girona-Alarcón1,2, Elena Fresán1,2, Ana Garcia-Garcia3
1Paediatric Intensive Care Unit, Institut de Recerca Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Insights
Multidrug-resistant bacterial infections in children are a growing concern. Key risk factors include young age and cardiovascular disease, leading to increased hospital stays and mortality.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Antimicrobial Resistance
Background:
- Multidrug-resistant bacterial infections pose a significant global health challenge, with limited data specific to pediatric populations.
- Device-associated infections are common in pediatric intensive care units (PICUs) and can be caused by resistant pathogens.
Purpose of the Study:
- To investigate the incidence, risk factors, and outcomes of device-associated infections in children.
- To specifically identify factors associated with multidrug-resistant bacterial infections in this age group.
Main Methods:
- A prospective, observational study was conducted in a PICU from 2008 to 2017.
- Included were children aged 1 month to 17 years with microbiologically confirmed device-associated infections.
- Patients with resistant bacterial infections were compared to those with drug-susceptible infections.
Main Results:
- Out of 213 patients, 22% (48) had infections caused by multidrug-resistant bacteria, most commonly extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.
- Risk factors for resistant infections included cardiovascular diseases, age under 1 year, comorbidity, prolonged invasive device use, and longer hospital stay.
- Patients with multidrug-resistant bacteria experienced increased length of stay and mortality.
Conclusions:
- Being under 1 year old and having cardiovascular disease are primary risk factors for resistant bacterial infections in children.
- While ESBL-producing bacteria were the most frequent resistant agents, they did not present additional risk factors, suggesting potential community acquisition.
Aim:
Multidrug-resistant bacterial infections are a public health problem worldwide. However, most of the information available refers to adults. The main objectives were to determine the incidence, risk factors, and outcomes for device-associated infections, especially those involving multidrug-resistant bacteria.
Methods:
This is a prospective, observational study. Children aged ≥1 month and <18 years admitted to the paediatric intensive care unit from 2008 to 2017, with a device-associated infection microbiologically confirmed were included. Patients infected with resistant bacteria were compared with those who had a drug-susceptible infection.
Results:
The study included 213 patients. Out of all the device-associated infections, 22% (48 patients) were caused by multidrug-resistant bacteria. The most frequent were extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Cardiovascular diseases, age under 1year, comorbidity, prolonged use of invasive device, and length of stay until infection were risk factors for resistant bacteria, but not specifically for ESBL-producing bacteria. Length of stay and mortality was increased in patients with multidrug-resistant bacteria.
Conclusion:
Being under 1-year-old and having a cardiovascular disease were the two major risk factors for resistant bacterial infection. ESBL-producing bacteria were the most frequent multidrug-resistant agents. However, patients with ESBL-producing bacteria did not have any additional risk factors, so they may have been colonised in the community.
