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Risk factors for multidrug-resistant bacteria in critically ill children and MDR score development
Cristina González-Anleo1,2, Mònica Girona-Alarcón3,4,5, Alba Casaldàliga1
1Pharmacy Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
European Journal of Pediatrics
|October 7, 2024
Summary
A new MDR score helps identify patients at high risk for multidrug-resistant infections in the pediatric intensive care unit (PICU). This tool aids in guiding empirical antibiotic therapy for better patient outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are critical issues in pediatric intensive care units (PICUs).
- Device-associated HAIs (DA-HAIs) caused by multidrug-resistant (MDR) bacteria pose significant risks, potentially leading to inappropriate empirical antibiotic therapy, adverse outcomes, and increased mortality.
- Prompt identification of patients at high risk for MDR infections is crucial for effective management.
Purpose of the Study:
- To develop and validate a risk score for the early identification of patients at high risk of developing multidrug-resistant (MDR) healthcare-associated infections (HAIs) in the pediatric intensive care unit (PICU).
- To assess the utility of the MDR score in stratifying patients and guiding empirical antibiotic therapy decisions.
Main Methods:
- A single-center, prospective, observational study was conducted from January 2015 to December 2022.
- Included were PICU patients with microbiologically confirmed DA-HAIs.
- Demographic, clinical characteristics, and outcomes were compared between MDR and non-MDR DA-HAI groups. A risk score was developed based on independent risk factors identified through univariate and multivariate analyses.
Main Results:
- Out of 257 DA-HAI cases, 86 (33.46%) were caused by MDR microbes.
- Independent risk factors for MDR-DA-HAI identified were previous comorbidity (OR 2.201), previous MDR colonization (OR 5.149), and PICU length of stay >9 days (OR 1.782).
- The developed MDR score demonstrated a global sensitivity of 82.6% for MDR-DA-HAI, with 91.8% specificity in the high-risk group. 81.0% of low-risk patients had non-MDR infections.
Conclusions:
- The MDR score is a valuable tool for stratifying patients into risk groups for MDR-DA-HAIs in the PICU.
- The score can assist in optimizing empirical antibiotic therapy, potentially reducing delays in appropriate treatment and improving patient outcomes.
- Individual patient risk stratification is essential for managing MDR infections effectively.
