The characteristics of infections caused by multidrug resistant gram negative bacteria in children

Infections caused by multidrug resistant Gram negative bacteria (MDR-GNB) have become an important health problem. Although there are several adult studies on the determination of risk factors for MDR-GNB infections, there are limited number of prospective studies including childhood age group. The aim of our study was to determine the risk factors and prognosis of MDR-GNB infections which are detected in the samples are taken from blood and other sterile body fluids, and rarely in non-sterile samples such as feces, sputum and to contribute to the literature. In our study, 89 patients with MDR-GNB infections and 54 patients as control group. Patients were included in the study between 1 month and 18 year aged. The most common MDR-GNBs in this study were E. coli and K. penumoniae. These pathogens are the most frequently isolated from urine culture. When the antibiotic resistance patterns of the microorganisms were categorized as MDR, XDR and PDR, most of them showed MDR. The most frequently detected pathogen, K. pneumoniae, was found to be 64.8% MDR, 25.9% XDR and 9.3% PDR. The second most common detected microorganism E. coli showed MDR in all the sample. Risk factors for MDR-GNB infections; underlying disease, surgical operation in the last 6 months, gastrostomy and ileostomy-colostomy, presence of central venous catheters other than port, antibiotic use in the last 6 months (4th generation cephalosporin, carbapenem, gliopeptide, aminoglycoside, fluoroquinolone), broad spectrum antibiotic use, presence of Gram negative and Gram positive bacteria in previous cultures, history of hospitalizations in the last 6 months, blood transfusion in the last 6 months, prophylactic antibiotics use, IVIG use. In order to prevent the infections of caused by MDR-GNBs in Turkey, it is necessary to carry out antibiotic stewardship programs in all hospitals and instutions providing health care services and control outcomes and avoid unnecessary antibiotic use. The data obtained in this study showed that amikacin, meropenem, ertapenem, imipenem, tigecycline and colistin were the most effective antibiotics in the treatment of MDR-GNB infections. In order to prevent and control MDR-GNB infections, it is important to comply with standard precautions such as hand hygiene, the sterilization of equipments and environmental cleaning. Shortening the duration of hospitalization ,as much as possible, should be one of the main precaution to prevent the MDR-GNB infections.