Risk factors for nosocomial bloodstream infection caused by multidrug resistant gram-negative bacilli in pediatrics

Abstract

The aim of this study was to identify the risk factors for nosocomial bloodstream infections by multidrug resistant Gram-negative bacilli. From November 2001 to December 2003, in the Pediatric Department of the Santa Casa de São Paulo, a retrospective case-control study was developed concerning patients who had nosocomial bloodstream infection caused by Gram-negative bacilli. Patients with multidrug resistant infections were designated as case patients, and control patients were those with an infection that did not meet the criteria for multidrug resistance. Previous use of central venous catheter and previous use of vancomycin plus third generation cephalosporins were associated to a higher chance of infections by multidrug resistant Gram-negative bacilli (Odds ratio -5.8 and 5.2, respectively). Regarding sensitivity of the isolated agents, 47.8% were multidrug resistant, 54.2% were Klebsiella spp. ESBL producers and 36.4% were imipenem resistant Pseudomonas aeruginosa. The lethality rate was 36.9% in the studied cases and this rate was significantly higher in the group of patients with multidrug resistant infections (p=0.013). Risk factor identification as well as the knowledge of the susceptibility of the nosocomial infectious agents gave us the possibility to perform preventive and control strategies to reduce the costs and mortality related to these infections.

Molecular epidemiology of carbapenem resistant gram-negative bacilli from infected pediatric population in tertiary - care hospitals in Medellín, Colombia: an increasing problem

“…It was also the most commonly found infection in this study, though the results contrast with those reported in other studies in which the most frequently occurring infections are bacteremia and pneumonia [1, 23, 25]. …”

“…Different studies have reported the relationship between the hospital environment and the presence of infections caused by resistant bacteria, which has been associated with mortality rates as high as 37 % in the pediatric population [1, 14, 23]. These infections particularly affect children under one year old, a feature that was observed in this study and that can be explained by the immunological immaturity of infancy, which leads to neonatal patients being more susceptible [23–26]. …”

“…Medical records show prior antibiotics use, predominantly carpabenems, in almost 95 % of patients in this study, which has been considered an independent risk factor for infections caused by resistant bacteria in both adults and children [11, 23, 29, 30]. These findings highlight the importance of establishing of antimicrobial stewardship programs as a strategy to control the spread of antibiotic-resistant bacteria in the pediatric population, and more importantly still, in neonatal and pediatric intensive care units where these medications are used the most frequently (55.8 %; 95 % CI: 50.3-61.3 %) [31].…”

Characterization ofEscherichia coliIsolates from Healthy Food Handlers in Hospital

“…Especially in clinics, multidrug-resistant bacteria have become more and more popular among nosocomial infections. 3,26 It is interesting to conduct a case-control study to investigate the prevalence of resistant isolates among healthy community residents and cooks in the community and hospitals.…”

Trends of 9,416 multidrug-resistant Gram-negative bacteria

“…9 Data from the Sentry antimicrobial surveillance program documented increases in MDR in Latin America, 10 as have other microbiological studies. [11][12][13][14] Few studies have evaluated hospitals in respect to the epidemiology and trends of overall resistance of MDR GNB. 15 Steady increases of different types of phenomena of multidrug resistance are observed in day-to-day practice in our hospital due to the growing complexity of procedures.…”