Determination of nosocomial infection agents and resistance distribution in inpati̇ent wards of the department of pediatrics

Introduction and Aim: Nosocomial infections, in other words, "healthcare-associated infections (HCAIs)" are defined as infections that develop during the care of the patient in the healthcare institution and are not present at the time the patient applies to the healthcare institution or are not in the incubation period. Although surveillance studies on HCAI have increased, studies in pediatric services are still limited. In this study, we aimed to determine the causes and susceptibility pattern of HCAIs among patients hospitalized in pediatric wards in a tertiary care center between 2016 and 2020. Methods: Patients who were treated at Bezmialem Vakif University Pediatrics Departments and diagnosed with HCAI were included in this study between January 2016 and December 2020. The diagnosis of HCAI was made according to the diagnostic criteria of the American Center for Disease Control (CDC) and the Turkish National Disease Surveillance Network (UHESA). The data of all patients were obtained through the hospital information management system. The microbiological results of clinical isolates and the clinical course of patients with HCAIs were recorded. Results: In a five-year retrospective evaluation, 297 microbiologically proven HCAIs were detected. The distribution according to the wards is:pediatric intensive care unit (PICU) (n=148, 49.8%), the neonatal intensive care unit (NICU) (n=76, 25.6%) and the pediatrics service (n=73, 24.6%) respectively. The most common HCAIs were bloodstream infections (BSI) (n=155, 52.2%), pneumonia (n=88, 29.6%), and urinary tract infections (UTI) (n=22, 7%, 4). Gram-negative bacteria constituted 64.9% of the pathogens while the frequencies of gram-positive bacteria and fungi were 23.4% and 11.7%, respectively. Regardless of the type of infection, the most frequently detected agents were Klebsiella spp. (20.4%), Pseudomonas aeruginosa (13%) and coagulase-negative staphylococci (CoNS) (12.7%). CoNS (22.2%), P. aeruginosa (26.1%), and Klebsiella spp (50%) were the major pathogens for BSIs, pneumonia, and UTIs, respectively. Methicillin resistance was detected in 92% of KoNS and 57% of Staphylococcus aureus strains. 50% of the E. coli and 30% of Klebsiella spp. Were ESBL positive. While no carbapenem resistance was detected in E. coli strains, 15% of Klebsiella spp, 20% of P. aeruginosa , 60% of Acinetobacter baumanii strains were found to be carbapenem-resistant. Two of the carbapenem-resistant Klebsiella strains (3.2%)nwere also resistant to colistin. None of the P. aeruginosa or A. baumanii strains were colistin resistant. Conclusion: Increasing resistance to antibiotics continues to be an important problem, especially in the selection of empirical treatment for critically ill patients. Studies on HCAIs in pediatric patients are limited. Continuous surveillance regarding patient profiles, the microorganisms that make up the hospital flora and their resistance properties, the distribution and frequency of HCAI in each department will enable the development of correct empirical treatment approaches against HCAI.