Evaluation of the characteristics of patients with growth of pan-drug resistant microorganisms in the pediatric intensive care unit

Objective: Hospital-acquired infections are a significant determinant of mortality in intensive care units. Particularly in pediatric intensive care units, infections caused by pan-drug-resistant organisms are increasing world wide. Patient characteristics remain a fundamental element in the management of pan-drug-resistant infections. In this study, we aimed to contribute to the literature on preventive measures that can be taken to reduce resistance by evaluating the characteristics of patients with growth of pan-drug-resistant microorganisms. Materials and Methods: Data of patients hospitalized in the Pediatric Intensive Care Unit of Gaziantep University Şahinbey Research and Training Hospital between March 2020 and October 2024, and who had at least one culture showing growth of pan-drug-resistant microorganisms processed in our laboratory during their stay, were retrospectively reviewed. Results: A total of 33 patients with pan-drug-resistant culture growth were included in the study. Of the patients, 75.8% were male and 24.2% were female. The mean age of the patients was 931±1330.86 days. The average length of hospital stay was 374.42±324.75 days. The most common reason for admission to the intensive care unit was respiratory failure (72.7%). Pan-drug-resistant microorganism growth was most frequently detected in tracheal aspirate culture samples (66.7%). The most commonly identified pathogen was Pseudomonas aeruginosa (51.5%). It was observed that 66.7% of the patients had received multiple antibiotics prior to culture sampling. The most commonly used antibiotics were colistimethate sodium (51.5%) and meropenem (48.5%). The mean number of days until culture growth occurred was 204.84±248.91 days. It was noted that 63.6% of the patients did not have a fever immediately before the culture was taken. All patients had invasive procedures and the most common invasive procedures was tracheostomy (75.7%, n=25). When patients with tracheostomy or intubation were considered, the proportion of patients receiving ventilator support reached 91% (n=30). Patients with more than one invasive intervention accounted for 60.6% (n=20). It was observed that therates of surgical intervention, inotropic therapy or total parenteral nutrition (TPN) were lower among those who received them compared to those who did not. Among the 22 deceased patients, 8 (36.3%) died with in 28 days after the detection of the microorganism growth. Although slightly elevated laboratory values were observed in most parameters in the deceased group, no statistically significant differences were found. Conclusion: Standardizing the selection of empiric antibiotics commonly used in intensive care units and initially preferring narrower-spectrum antibiotics that are effective against potential microorganisms may help prevent the development of antibiotic resistance. Furthermore, the limited options available for treating microorganisms commonly seen in intensive care units should be taken into account, and care should be taken to choose antibiotics that are effective against these organisms, even when using narrow-spectrum antibiotics. A common finding of studies on this subject is that the most common source of growth resistant to all antibiotics is tracheal aspirate culture. Ensuring proper hygiene during the care and suctioning of patients receiving mechanical ventilation, and developing specific care and hygiene algorithms for these patients, may be effective in preventing the spread of such microorganisms. Keywords: Pediatric Intensive Care Unit, hospital-acquired infections, antibiotic resistance, microorganisms resistant to all antibiotics