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Colonization with antibiotic-resistant gram-negative organisms in a pediatric intensive care unit
P Toltzis1, T Yamashita, L Vilt
1Division of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Antibiotic-resistant Gram-negative organisms colonize over 20% of pediatric ICU patients, often within 72 hours of admission. Prior antibiotic use was not an independent risk factor for colonization.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Antibiotic-resistant Gram-negative organisms pose a significant threat in pediatric intensive care units (ICUs).
- Understanding colonization prevalence and risk factors is crucial for infection control.
Purpose of the Study:
- To determine the prevalence of colonization with antibiotic-resistant Gram-negative organisms in a pediatric ICU.
- To identify potential risk factors associated with this colonization, including antibiotic exposure.
Main Methods:
- Prospective, observational study conducted in a 16-bed tertiary care pediatric ICU.
- Enrolled 296 children admitted for >24 hours over 5 months; 236 analyzed.
- Assessed nasopharyngeal and gastrointestinal colonization by specific resistant Gram-negative organisms.
Main Results:
- Over 20% of patients were colonized with antibiotic-resistant Gram-negative organisms.
- More than half of colonizations were identified within 72 hours of ICU admission.
- Unadjusted analysis showed associations with prior antibiotic exposure, illness severity (PRISM score, instrumentation), and young age; however, logistic regression found prior antibiotic exposure was not an independent risk factor.
Conclusions:
- Antibiotic-resistant Gram-negative organisms represent a substantial risk to critically ill children in the ICU.
- Colonization is often acquired early, potentially from imported sources or environmental reservoirs.
- Given multiple risk factors, ICU-specific antibiotic stewardship policies may have limited impact on controlling resistant organism colonization.
Objective:
To measure the prevalence of colonization with antibiotic-resistant Gram-negative organisms and its association with potential risk factors, including antibiotic exposure, in a pediatric intensive care unit (ICU).
Design:
Prospective, observational study.
Setting:
A 16-bed tertiary care pediatric ICU.
Patients:
All children admitted to the pediatric ICU for > 24 hrs over a 5-month period.
Measurements And Main Results:
Two hundred ninety-six patients, approximately half of all patients admitted to the ICU, were enrolled in the study; 236 patients had sufficient data collected for analysis and were prospectively examined for nasopharyngeal and gastrointestinal colonization by antibiotic-resistant Gram-negative organisms (ceftazidime minimal inhibitory concentration of > 16 micrograms/mL, or tobramycin minimal inhibitory concentration > 8 micrograms/mL). Association between colonization and potential predisposing factors including demographics, diagnosis, Pediatric Risk of Mortality (PRISM) score, invasive instrumentation, and prior ICU antibiotic exposure was assessed. More than 20% of patients were found to be colonized with an antibiotic-resistant Gram-negative organism. Examination of the timing of colonization indicated that more than half were identified within 72 hrs of admision. Colonization was associated by unadjusted analysis to prior ICU antibiotic exposure, as well as by factors associated with the severity of illness (PRISM score and invasive instrumentation) and young age. However, when the independence of these factors was tested by logistic regression, prior antibiotic exposure was no longer associated with resistant organism colonization.
Conclusions:
These data suggest that antibiotic-resistant Gram-negative organisms are a significant risk to intensively III children and that in many instances, they are imported into the unit or rapidly acquired from environmental reservoirs. Since risk factors for colonization are multiple, policies confined to antibiotic utilization within the ICU may have fixed, and possibly limited, benefit in their control.