1 - Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central.
2 - Unidade de Infecciologia, Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central.
3 - Unidade de Cuidados Intensivos Pediátricos, Área de Pediatria Médica, Hospital de Dona Estefânia, Centro Hospitalar Universitário Lisboa Central
4 - Grupo Local de Coordenação da Prevenção e Controlo de Infeção e Resistência Antimicrobiana, Centro Hospitalar Universitário Lisboa Central, Hospital de Dona Estefânia.
- 41st Annual Meeting of the European Society for Paediatric Infectious Diseases; reunião internacional (poster com discussão)
Introduction: Susceptibility to infection with gram negative microrganisms in PICU is increased, mainly due to the frequent use of invasive devices, implying a growing number of manipulations, bacterial contamination, and colonization. This study aimed to identify the risk factors for 30-day mortality in PICU patients with Enterobacteriaceae multidrug-resistant (MDR) infections and compare the clinical outcomes and various antimicrobial regimens.
Methods: A retrospective, observational study was performed on patients admitted to the PICU with MDR Enterobacteriaceae infection, in accordance with the Magiorakos definition between January 2013 and December 2022. Data were obtained from patient records and analyzed using SPSS 22®.
Results: Forty-five patients were admitted to the PICU with MDR enterobacterial infections, 53% female, median age was 45 months (min 1, max 216 mo) and 91% (n=41) had history of underlying pathology. Sixty-four percent required mechanical ventilation and 28% had septic shock. The majority (96%) had at least one invasive device, central lines present in all cases. The correct choice of antibiotics was confirmed in 32 patients (71%), but adjustment to recent guidelines was 46%. The most frequently used antibiotic was meropenem (n=17). The most isolated Enterobacteriaceae was Klebsiella pneumonia on 23% (24 of the series). Thirty-day adjusted mortality risk factors were septic shock (OR 5,062;95% CI:1,140-22,485), neutropenia (OR 5,176; 95% CI:1,004-26,597) and immunodeficiencies (OR 7,111;95% CI:1,258- 40,207). Overall mortality was 24% (n=11), but if adjusted to 30 days, 22% (n=10).
Conclusion: Our study suggests that MDR Enterobacteriaceae infections primarily affected children with immunosuppression and presentation is severe, with higher overall mortality despite antibiotic sensitivity testing oriented therapy.
Palavras Chave: Antimicrobials; Enterobacteriaceae multidrug-resistant; Intensive care.