Patterns of Antimicrobial Resistance in a Pediatric Cardiac Intensive Care Unit: Five Years’ Experience

Year 2017, Volume: 07 Issue: 03, 132 - 138, 15.09.2017

Nelya Bissenova Aigerim Yergaliyeva

https://doi.org/10.5799/jmid.367532

Cited By: 1

Abstract

Objectives: The identification of antimicrobial resistance of
isolates present in pediatric cardiac intensive care unit (PCICU) is important
to prevent further spread, because this department limited choice of
antibiotic. The aim of the present study is to report the antibiotic resistance
rate of most frequently pathogens in PCICU during a five-year period.

Methods:
A prospective study was performed on 4228 clinical samples (bloodstream, wound
samples, respiratory tract, tracheobronchial tree, and central venous catheter)
from patients in PCICU during the period 2012-2016. Identification of isolates
and antibiotic susceptibility testing were performed by Vitek 2 automated
system.

Results:
The percentages of most frequently isolated microorganisms in our PCICU were as
follows: Klebsiella pneumoniae 8.9%, Pseudomonas aeruginosa 7.5%, Staphylococcus
aureus 6.9%, Coagulase-Negative Staphylococci
5.3%, and Candida spp. 3.4%.
During study period there is tendency increasing the percentage of detection P. aeruginosa from 2.6% to 10.8%
(p=0.018), K. pneumoniae from 2.6% to
10.5% (p=0.023), and Candida spp. from 1.6% to 5.9% (p=0.033). These
isolates showed tendency of significant increasing resistance to 3rd generation
cephalosporins and carbapenems.

Conclusion: The present study
reported that most frequent isolates in our PCICU were P. aeruginosa and K. pneumoniae. Reporting of dramatically
increasing resistance rates of these isolates necessitates a well-designed
hospital infection control strategy, including good hygiene, microbiological
monitoring; all of this will greatly reduce the risk of nosocomial infection.

Keywords

microbiologic monitoring, antibiotic resistance, pediatric cardiac intensive care unit

References

• 1. Brown PP, Kugelmass AD, Cohen DJ, Reynolds MR, Culler SD, Dee AD. The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program. Ann Thorac Surg 2008; 85: 1980-1986. 2. Valera M, Scolfaro C, Cappello N, Gramaglia E, Grassitelli S, Abbate MT. Nosocomial infections in pediatric cardiac surgery, Italy. Infect Control Hosp Epidemiol 2001; 22: 771-775. 3. Vida VL, Leon-Wyss J, Larrazabal A, Cruz S, Castaneda AR. Mediastinitis in pediatric cardiac surgery: treatment and cost-effectiveness in a low-income country. Pediatr Cardiol 2007; 28: 163-166. 4. Holzmann-Pazgal G, Hopkins-Broyles D, Recktenwald A, Hohrein M, Kieffer P, Huddleston C. Case–control study of pediatric cardiothoracic surgical site infections. Infect Control Hosp Epidemiol 2008; 29: 76-79. 5. Mehta PA, Cunningham CK, Colella CB, Alferis G, Weiner LB. Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J 2000; 19:1000-1004. 6. Becerra MR, Tantaleán JA, Suárez VJ, Alvarado MC, Candela JL, Urcia FC. Epidemiologic surveillance of nosocomial infections in a pediatric intensive care unit of a developing country. BMC Pediatrics 2010;10:66-71. 7. Singhi S, Rao DS, Chakrabarti A. Candida colonization and candidemia in a pediatric intensive care unit. Pediatr Crit Care Med 2008; 9:91-95. 8. Jefferies JM, Cooper T, Yam T, Clarke SC. Pseudomonas aeruginosa outbreaks in the neonatal intensive care unit - a systematic review of risk factors and environmental sources. J Med Microbiol 2012; 61: 1052-1061. 9. Urrea M, Pons M, Serra M, Latorre C, Palomeque A. Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 2003; 22:490-494. 10. Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD, et al. Pediatric Prevention Network. A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 2002; 140:432-438. 11. Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR. Pediatric Prevention Network. Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units. Am J Infect Control 2001; 29:152-157. 12. Barker GM, O’Brien SM, Welke KF, Jacobs ML, Jacobs JP, Benjamin DK, Peterson ED, Jaggers J, Li JS. Major infection after pediatric cardiac surgery: at risk estimation model. Ann Thorac Surg 2010; 89(3): 843-850. 13. Almuneef MA, Memish ZA, Balkhy HH, et al. Rate, risk factors and outcomes of catheter-related bloodstream infection in a pediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006; 62: 207-213. 14. Guidelines of standards for microbiologic tests in the laboratory of clinical microbiology. Astana, 2008:11-12 15. Porto JP, Mantese OC, Arantes A, et al. Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance. Rev Soc Bras Med Trop 2012; 45: 475-479. 16. Becerra MR, Tantaleán JA, Suárez VJ, et al. Epidemiologic surveillance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country. BMC Pediatr 2010; 10:66-72. 17. Grisaru-Soen G, Sweed Y, Lerner-Geva L, et al. Nosocomial bloodstream infections in a pediatric intensive care unit: 3-year survey. Med Sci Monit. 2007;13(6):251-257. 18. Lodha R, Natchu UC, Nanda M, Kabra SK Nosocomial infections in pediatric intensive care units. Indian J Pediatr 2001;68(11):1063-1070. 19. Ning B-T, Zhang C-M, Liu T, Ye S, Yang Z-H, Chen Z-J. Pathogenic analysis of sputum from ventilator-associated pneumonia in a pediatric intensive care unit. Experim and Therap Med 2013; 5(1):367-371. 20. Pfaller MA, Diekema DJ, Jones RN, et al. SENTRY Participant Group. International surveillance of bloodstream infections due to Candida species: Frequency of occurrence and in vitro susceptibilities to fluconazole, ravuconazole, and voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surveillance program. J Clin Microbiol 2001; 39:3254–3259. 21. Zaoutis TE, Coffin SE, Chu JH, et al. Risk factors for mortality in children with candidemia. Pediatr Infect Dis J 2005; 24:736–739. 22. Marodi L, Johnston R. Invasive Candida species disease in infants and children: occurrence, risk factors, management, and innate host defense mechanisms. Curr Opin Pediatr 2007; 19: 693-697. 23. García L, Cobo J, Martos I, et al. Risk factors for candidemia in pediatric patients with congenital heart disease. Infect Control Hosp Epidemiol 2006; 27: 576-580. 24. Chow J, Golan Y, Ruthazer R. Risk factors for albicans and non-albicans candidemia in the intensive care unit. Crit Care Med 2008; 36: 1993-1998. 25. Alotaibi MG, Rahman S, Shalaan MA, Omair A. Frequency of nosocomial infections in pediatric intensive care unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia. J Infect Dis Ther 2015; 3(5):234-237 26. Jaballah NB, Bouziri A, Mnif K, et. al Epidemiology of hospital-acquired bloodstream infections in a Tunisian pediatric intensive care unit: A 2-year prospective study. Amer J Infect Control 2007; 35(9):613-618. 27. Koleff MH. The prevention of ventilator associated pneumonia. NEJM 1999; 340:627-641. 28. Johanson WG, PierceAK, Sanford JP, Thomas GD. Nosocomial respiratory infections with gram negative bacilli: the significance of the colonization of the respiratory tract. Ann Intern Med 1972; 77:701-706. 29. Carvalho CE, Berezin EN, Pistelli IP, Mímica L, Cardoso MR. Sequential microbiological monitoring of tracheal aspirates in intubated patients admitted to a pediatric intensive care unit. J Pediatr 2005; 81(1):234-240. 30. Mammina C, Carlo PD, Cipolla D, et al. Nosocomial colonization due to imipenem-resistant Pseudomonas aeruginosa epidemiologically linked to breast milk feeding in a neonatal intensive care unit. Acta Pharmacologica Sinica 2008; 29:1486–1492 31. Lee CY, Chen PY, Huang FL, Lin CF. Microbiologic spectrum and susceptibility pattern of clinical isolates from the pediatric intensive care unit in a single medical center - 6 years’ experience. J Microbiol Immunol Infect 2009; 42:160-165 32. Wang LJ, Sun Y, Song WL, Zhang ZJ, Liu CF. Changes of drug-resistance of Pseudomonas aeruginosa in pediatric intensive care unit. Chin J Pediatr 2012; 50(9):657-663.