Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care

Abstract

Background Healthcare-associated infections (HCAI) are a worldwide threat in intensive care units particularly in the pediatric intensive care units with a major cause of morbidity and mortality among this age group. The aim of the study is to determine the prevalence and risk factors predisposing to multidrug-resistant organisms (MDROs) infections among pediatric intensive care unit (PICU) patients at Ain Shams Pediatric University Hospitals as well as determining mortality and morbidity rates along with the length of stay at PICU. Results Culture results revealed that of the 282 patients evaluated, only 26 (9.2%) were MDROs (half of the affected patients had Acinetobacter species (50%) and the rest of them were free, 256 (90.8%). Our study revealed that the majority of MDROs were isolated from sputum in more than half of the patients 19/32 (59.3%) followed by whole blood in 10/32 (31.2%) and urine in 3/32 (9.4%). Pulmonary system was the most common affected site and was mainly colonized by MDR Acinetobacter (71.4%) followed by MDR Klebsiella (41.6%). Regarding MDR risk factors in our PICU, multivariate logistic regression analyses showed significant relationship between MDROs and age under 1 year (odds ratio [OR] 2.4554; 95% confidence interval [95% CI] (1.072–5.625); p = 0.043) and underlying pulmonary disease (OR 2.417; 95% CI (1.014–5.761); p = 0.592). A statistically significant higher mortality was detected in patients colonized with MDROs 9/26 (34.6%) versus MDROs non-colonized patients 32/256 (12.5%) [P=0.002]. Moreover, MDROs infection has negative significant risk with discharged patients ([OR] 0.269; [95% CI] (0.111–0.656); p = 0.002). Additionally, patients infected with MDROs did have significantly greater PICU stay than those non-infected [median (IQR), 16.5 (10.7–22), 5 (4–8), P=0.00] and have longer ventilation [median (IQR), 15.5 (10–18), 3 (2–10), P=0.00]. Conclusion Prevalence of MDROs (9.2%) was low among PICU cases at Ain Shams University Hospitals. Most common MDROs were Acinetobacter and Klebsiella followed by pseudomonas species. The frequency of gram-negative organisms is much more common than gram-positive organisms. An increasing rate of antimicrobial resistance with increasing mortality and morbidity among PICU patients is observed worldwide; even for new categories, so, strict infection control programs should be implemented.

Prevalence and determinants of antimicrobial resistance of pathogens isolated from cancer patients in an intensive care unit in Alexandria, Egypt

“…A similar trend was also reported locally in Egypt by Khalifa et al [ 29 ], as well as globally among patients with underlying malignancies in tertiary hospitals by Paul et al [ 30 ] and Garg et al [ 6 ]. This was in contrast to the study carried out by Rezk et al in a critical care unit in Egypt that reported Acinetobacter baumannii as the predominant organism [ 31 ]. Moreover, Sheth et al found that among ICU patients, Acinetobacter spp.…”

Rate of Multidrug-resistance to Antimicrobial Drugs in Patients in Pediatric Neurointensive Care

“…Rezk et al found a significant relationship between MDR organisms and underlying pulmonary disease. 24 In our study, cardiac disease was found as an additional risk factor along with respiratory disease for MDR infection. Age below 2 years along with more than 3 days of hospital stay was identified as a risk factor for the acquisition of MDR.…”

“…In a study by Rezk et al, authors evaluated 282 pediatric ICU patients of which only 9.2% were colonized with MDR Gram-negative bacteria; of them, nearly half were affected by Acinetobacter species (50%). 24 In another study by Rhim et al, in subarachnoid hemorrhage (SAH) patients, extended-spectrum β-lactamase producing bacteria were the commonest ( E. coli and K. pneumoniae ) followed by methicillin-resistant Staphylococcus aureus , MDR Gram-negative rods, and vancomycin-resistant enterococci. 25 In our study, out of 274 patients enrolled, 31 MDR episodes were identified.…”

Bacteriological profile and antibiotic susceptibility pattern of septicemia in neonatal intensive care units in Palestine: A retrospective study

“…According to a study in Egypt, only 9.2% of the cases tested positive for MDRO [15] . This study found that one-third of cultures tested positive for MDRO, indicating a lack of antimicrobial stewardship programs and inadequate implementation of infection control policies [ 16 , 17 ].…”