Imipenem MIC was markedly increased among K. pneumoniae isolates showing AmpC production with loss of both porins OmpK35/36. Meanwhile, the association of porin OmpK35/36 loss with ESBL production was not a direct cause of resistance to imipenem.

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Background: Bacterial resistance to commonly used antimicrobial agents is growing up day by day in both community and hospital settings.Therefore this study was initiated to benchmark prevailing resistance rates for the most common bacterial pathogens in PED of Specialized Pediatric Hospital aiming to be able to design local data-based antibiotic policy. Methods & Materials: A cross sectional study performed on 970 patients selected from 1085 cases admitted to PED from August 2011-August 2012. All specimens were collected, processed, cultured and the isolates were identified according to the standard microbiological techniques. AST of all isolates was determined following the performance standards set by CLSI. Results: Pneumonia cases were the commonest (79%). The predominant pathogen in pneumonia was pseudomonas (27.7%), while CONS (42.9%) and E.coli (63.6%) were the most prevalent in sepsis and UTI respectively. Methicillin resistance was encountered in 75% of Staphylococci aureus and 99% of CONS isolates. All Ecoli (100%) and 73% of Klebsiella spp. strains exhibited phenotypic ESBL patterns. Antibiotic sensitivity pattern in pneumonia was; ciprofloxacin 43.4%, imipenem 42.3% and meropenem 37% in Gram negative organisms, while Gram positive organisms showed 100% sensitivity to vancomycin, teicoplanin, clindamycin and erythromycin and 66% to doxycycline. In sepsis; Gram negative organisms were sensitive to: ciprofloxacin 67%, aztreonam 53.6%, gentamycin 41.3%, imepenem 40.6%, and amikacin 36% and Gram positive organisms were 100% sensitive to vancomycin, 86.5% to teicoplanin and 42.5% to clindamycin. Gram negative organisms isolated from patients with UTI showed highest sensitivity to: ciprofloxacin 83.3%, meropenem 44.3% and amikacin 25%, while Gram positive organisms were 100% sensitive to vancomycin and gentamycin. Conclusion: Alarming increase in MDR organisms, enhancing demands to review strictly the infection control measures to limit development and spread of bacterial resistance. Establishment of antibiotic policy guided by the collected data in our study, which is updated periodically according to microbiology laboratory reports to monitor variations in pathogen occurrences and emerging antimicrobial resistance, especially because a new agents such as fluoroquinolones are recently used to a greater extent in this age group.

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