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Surveillance of Multidrug-Resistant Organisms and Trends in Antimicrobial Susceptibility in Chronically Hospitalized
Yoon Kyung Cho1,2, Ye Ji Kim1,2, Shin Young Park3
1Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
This 10-year study found low bloodstream infection rates in pediatric long-term care patients. However, increasing methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) colonization requires enhanced infection control strategies.
Area of Science:
- Pediatric Infectious Diseases
- Healthcare Epidemiology
- Antimicrobial Resistance Surveillance
Background:
- Long-term care facilities (LTCFs) pose increased infection risks for patients, including those with invasive devices and multidrug-resistant organisms.
- Pediatric populations in LTCFs are particularly vulnerable due to chronic underlying conditions.
Purpose of the Study:
- To analyze infection surveillance and clinical specimen culture results in pediatric patients residing in a long-term care facility.
- To evaluate trends in antimicrobial susceptibility and the prevalence of key resistant organisms over a decade.
Main Methods:
- Retrospective data collection from January 2015 to December 2024 at a dedicated pediatric LTCF.
- Inclusion of all hospitalized patients undergoing clinical specimen collection for surveillance or evaluation.
- Analysis of bacterial isolates, bloodstream infection (BSI) episodes, and antimicrobial resistance patterns.
Main Results:
- A total of 216 bacterial isolates were identified from 130 medically complex pediatric patients (4.7% positivity rate).
- Low incidence of bloodstream infections (BSI) (0.21 per 1,000 resident-days) with 14.3% attributable mortality.
- Significant increases observed in methicillin-resistant Staphylococcus aureus (MRSA) colonization (3.5% to 5.9%) and carbapenem-resistant Enterobacteriaceae (CRE) rectal positivity (0% to 3.4%) between 2016-2024.
Conclusions:
- The study indicates a low BSI incidence in this pediatric LTCF population, potentially due to effective infection control.
- Rising trends in MRSA and CRE colonization highlight the critical need for ongoing surveillance.
- Development of pediatric-specific infection prevention strategies is essential to combat emerging resistance.
Background:
Patients in long-term care facilities experience greater risk of infections, along with use of long-lasting invasive devices and colonization of multidrug resistant organisms. This study aims to analyze surveillance and clinical specimen culture results and trends in antimicrobial susceptibility among long-term hospitalized pediatric patients.
Materials And Methods:
Data were collected retrospectively from January 2015 to December 2024 from a long-term care facility dedicated to children with chronic underlying diseases. All hospitalized patients that underwent clinical specimen collection as part of infection surveillance or clinical evaluation were included.
Results:
From 2015 to 2024, 759 admissions (357 new, 402 readmissions) were recorded, and 4,623 clinical specimens were collected. A total of 216 bacterial isolates were identified (4.7% positivity rate) from 130 medically complex pediatric patients, 98.8% of whom were bedridden. Between 2019 and 2024, 14 bloodstream infection (BSI) episodes occurred in 12 patients, with 85.7% suspected to be catheter-related. The BSI isolation rate was 0.21 per 1,000 resident-days, and the BSI-attributable mortality rate was 14.3%. From 2016 to 2024, methicillin-resistant Staphylococcus aureus (MRSA) nasal/sputum positivity increased from 3.5% to 5.9%, and the MRSA isolation rate rose significantly from 0.128 to 0.367 per 1,000 resident-days (P=0.009). Rectal carbapenem-resistant Enterobacteriaceae (CRE) positivity increased significantly from 0% to 3.4% (P=0.004), with isolation rates rising from 0 to 0.149 per 1,000 resident-days (P=0.012).
Conclusion:
This 10-year study highlights a low incidence of BSIs in a medically complex pediatric long-term care population, likely due to proactive infection control measures. However, rising trends in MRSA and CRE colonization underscore the need for continued surveillance and the development of pediatric-specific infection prevention strategies.
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