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Rate of Multidrug-resistance to Antimicrobial Drugs in Patients in Pediatric Neurointensive Care
Swapnil Patel1, Hemanshu Prabhakar1, Indu Kapoor1
1Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Insights
Multidrug-resistant infections are a concern in pediatric neurocritical care. This study found an infection rate of 17.3 per 1,000 patient days, with Klebsiella pneumoniae being the most common pathogen.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Neurosurgery
Background:
- Multidrug-resistant (MDR) organisms pose a global threat, particularly in critical care settings.
- Pediatric neurocritical care patients are vulnerable due to factors like altered mental status and immature immune systems.
- This study aimed to quantify the burden of MDR infections in a pediatric neurosurgical intensive care unit (NSICU).
Observation:
- The study included 274 pediatric patients (1-18 years) undergoing intracranial or spine surgeries, admitted for over 48 hours.
- Infections monitored included pneumonia, bloodstream infections (BSI), and urinary tract infections (UTI) in patients with mechanical ventilation or indwelling devices.
- Data collected included organism type, MDR infection rates, and associated risk factors, with statistical analysis using Pearson Chi-squared and Fisher's tests.
Findings:
- An overall MDR infection rate of 17.3 per 1,000 patient days was observed.
- Klebsiella pneumoniae was the most frequent MDR pathogen, accounting for 38.7% of cases.
- Bloodstream infections represented the most common source of infection (32.3%).
- Significant risk factors for MDR infections included prolonged NSICU stay, extended mechanical ventilation, emergency surgery, comorbidities, and poor nutritional status.
Implications:
- The findings highlight a significant rate of MDR infections in pediatric neurocritical care.
- Identifying Klebsiella pneumoniae as a primary pathogen guides targeted antimicrobial strategies.
- Understanding risk factors allows for the development of preventative measures and improved patient management in NSICU settings.
Background:
Multidrug-resistant (MDR) organisms in the critical care unit are a worldwide concern. The vulnerability to MDR infection in pediatric patients admitted in neurocritical care are due to altered mental status, immature immune system, higher risk of aspiration, and more frequent use of invasive devices. We aimed to measure the burden of MDR infection in pediatric neurosurgical intensive care unit (NSICU) patients.
Methods:
All pediatric patients between 1 and 18 years for intracranial and spine surgeries admitted for more than 48 hours in NSICU were enrolled in the study. If patients showed a clinical picture of pneumonia, bloodstream infection (BSI), or urinary tract infection (UTI) after receiving mechanical ventilation or an indwelling device for at least 48 hours, samples of tracheal aspirates, urine, blood, and cerebrospinal fluid (CSF) were sent for microbiological culture. We noted the type of organism, MDR infection rate, and associated risk factors. Pearson Chi-squared test and Fisher's test were used for statistical analysis; p < 0.05 was considered statistically significant.
Results:
A total of 274 pediatric patients were studied. In 1 year, there was a total of 1,790 patient days. The inclusive MDR infection rate was 17.3/1,000 patient days. Also, Klebsiella pneumoniae (38.7%) was the commonest MDR pathogen. The commonest source of infection was BSI (32.3%). The risk factors associated with MDR infections were the length of stay in NSICU, mechanical ventilation of more than 5 days, emergency surgery, respiratory and cardiac comorbidities, and poor nutrition status (p < 0.05).
Conclusion:
The MDR infection rate in our study was 17.3/1,000 patient days in pediatric patients. Also, K. pneumonia e was found to be the commonest MDR pathogen. Bloodstream was the commonest source of infection.
How To Cite This Article:
Patel S, Prabhakar H, Kapoor I. Rate of Multidrug-resistance to Antimicrobial Drugs in Patients in Pediatric Neurointensive Care. Indian J Crit Care Med 2023;27(1):67-72.
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