Evaluation of Gram-negative hospital-acquired infections and antibiotic resistance in the pediatric intensive care unit

Abstract

Introduction: We retrospectively analyzed the frequency of healthcare-associated infections (HAIs), infection sites, Gram-negative microorganisms in the cultures, and antibiotic resistance patterns; recorded in the pediatric intensive care unit (PICU); between 2017 and 2023; based on the records in our hospital's infection control surveillance system. Our aim was to determine the state of infections over the years and the status of antibiotic resistance.

Methodology: Medical records of PICU patients, between 1 January 2017 and 31 July 2023, whose cultures were identified to have Gram-negative bacterial growth, were evaluated retrospectively.

Results: A total of 125 nosocomial infections were recorded. Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequently identified and had equal growth rates in blood culture. K. pneumoniae were most frequently identified in the central venous catheter (CVC). Mortality was significantly higher for patients with fungal growth, congenital diseases, and males (p < 0.05); except in patients with CVC. Patients with congenital diseases had a shorter median survival time (65 days) compared to chronic disease patients (151 days; p < 0.005). Cox regression analysis indicated that comorbidity was a significant risk factor for survival time. The risk of mortality was 3.074 times higher in patients with congenital disease compared with chronic disease patients (HR = 3.074; 95% CI: 1.577–5.995). Gender had a significant relationship with mortality; however, survival times did not differ between genders (p > 0.05).

Conclusions: Gram-negative bacterial infections are becoming more prevalent in intensive care units, and effective control and prevention policies are needed for these infections.