The detection of pediatric patients with carbapenem-resistant gram(-) bacterial infections, to determine the clinical features of the patients before and after treatment, and the comparation with patients with carbapenem-susceptible gram(-) bacterial infections for the risk factors

Introduction and aim Multidrug-resistance against Gram(-) bacterias has become an emergence worldwide. The data for pediatric patients is not enough as for the adult patients about risk factors and clinical features. Carbapenem-resistance makes the treatment options limited and morbitity and mortality due to nosocamial infections is increasing. The aim of this study is to determine the demografic features, risk factors and the treatment options that the clinians use in treatment of carbapenem- resistant Gram(-) bacterial infections in pediatric patients. Materials and Methods A matched case-control (27/24) study was conducted from April 2014 to December 2014 in pediatric departments, intensive case unit and neonatal intensive case unit of Ege University, İzmir, Turkey. Case group was defined as patients isolated carbapenem-resistant Gram(-) bacteria and control group was defined as patients isolated carbapenem-susceptible Gram(-) bacteria. We compared the groups for the risk factors, demografic features, susceptibility profiles of the isolated pathogens, the treatment protocols and fatality rate. Results During the 8-month study period, 27 case subjects and 24 control subjects were identified. Among the case group 6(22.2%) of the 27 patients were from the depatments, 15(%55.5) of the 27 patients were from the intensive care unit, 5(18.5) were from the neonatal intensive care unit and 1(3.7%) was from oncology department. The case group consisted of 27(17M/10F) patients and the control group consisted of 24(16M/8F) patients. The most common underlying disease was chronic lung disease(n=4)in case group, genetic sendrom in control group. The patients were compared for the predispozan factors; receiving carbapenem treatment regimen before the bacteria isolation and the period of hospitalization were significantly higher in the case group, respectively (p=0.007, p=0.025). There was no significiant difference in the level of acute phafe reactants between groups. The patients who have carbapenem resistant Gram(-) bacterial infection had higher risk for septic şok (p=0.037). The suspectibility profile was also compared and ciprofloxasin resitance was more common in case group (p<0.001). The duration of the blood culture clearation was shorter for the patients who received 3. generation cephalosporines antibiotics (p=0.022). At the end, we compared the mortality was significantly higher in the case group (p=0.017). Conclusion Carbepenem resistant Gram(-) bacteria are more common isolated at the pediatric departments. Receiving antibiotic regimens including carbapenems and long hospitalization period were found to be the risk factors for carbapenem-resistant Gram(-) bacteremia. The possibility of septic shock was enhanced for the patients who have carbapenem-resistant Gram(-) bacteremia. Acut phase reactants were not found to be significant for the clinians. And using third generation cephalosporins shortened the period of bood culture clearation.