1 - Pediatrics Department Centro Hospitalar Universitário Lisboa Central, Hospital de Dona Estefânia, Lisbon, Portugal
2 - Infectious Disease Unit Centro Hospitalar Universitário Lisboa Central, Hospital de Dona Estefânia, Lisbon, Portugal
3 - Intensive Care Unit Centro Hospitalar Universitário Lisboa Central, Hospital de Dona Estefânia, Lisbon, Portugal
4 - Local Coordination Group of the Infection Prevention and Control Program and Antimicrobial Resistance, Centro Hospitalar Universitário Lisboa Central, Hospital de Dona Estefânia, Lisbon, Portugal
- Apresentação sobre a forma de poster: 32nd Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care
Introdution: Several publications have been furthering our understanding in the management of health care associated gram-negative bacterial multidrug resistant (GNMDR) infections in pediatric intensive care units (PICU).
Methods: Retrospective unicentric descriptive and comparative analysis of patients (0–18 years) admitted to the PICU, between 2013 and 2022 in which GNMDR, by Magiorokis definition, infections were identified.
Results: 66 patients were admitted to the PICU with GNMDR infections, with median age of 12 months (1-228 mo), 51% males. Most GNMDR (75%) were Enterobacteriaceae, more frequently Klebsiella pneumoniae (39%), Pseudomonas aeruginosa and Escherichia coli (both 16%). Identification was more frequent in urine samples. Antibiotic prescription was adjusted to antibiotic sensitivity testing in 67% of cases, the most common antibiotics being meropenem (41%) and vancomycin (38%). Most patients required mechanical ventilation (64%), which wasn’t associated with site of infection (p=0.12). Most (97%) required at least one invasive device, which was not associated with site of infection (p=0.728). The most frequent comorbidity was congenital malformation (28%). Neutropenia was present in 23% of cases, immune suppression in 34% and septic shock in 28%. Seventeen patients died (27%) and 30-day adjusted mortality was 23%. Neutropenia (OR 4.48 [95% CI 1.26- 15.91]), immunodeficiency (OR 5.58 [95% CI 1.09-28.60]) and septic shock (OR 6.67 [95% CI 1.89-23.52]) were associated with increased risk of 30-day mortality.
Conclusions: MDRGN infections showed an aggressive clinical presentation. Neutropenia and immunodeficiency may increase the overall mortality in these patients. Recent publications have changed the management of these infections, which may account for the disparity in antibiotic prescription adequacy.
Palavras Chave: Antimicrobials; gram-negative bacterial multidrug resistant; infection, systemic inflammation; sepsis