Multi-drug resistant gram negative infections and use of intravenous polymyxin B in critically ill children of developing country: retrospective cohort study.

Naveed-Ur-Rehman Siddiqui,Farah Naz Qamar,Anwarul Haque,Humaira Jurair

doi:10.1186/s12879-014-0626-9

Naveed-Ur-Rehman Siddiqui, Farah Naz Qamar + Show 2 more

Open Access

https://doi.org/10.1186/s12879-014-0626-9

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Journal: BMC infectious diseases	Publication Date: Nov 28, 2014
Citations: 54	License type: CC BY 4.0

Affiliation: Aga Khan University

Abstract

BackgroundPatients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care.To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. We also report safety of Polymyxin B use in these patients.MethodsFiles of patients admitted in PICU of Aga Khan University Hospital, from January 2010 to December 2011, one month to 15 years of age were reviewed. Demographic and clinical features of patients with MDR gram negative infections, antibiotic susceptibility pattern of isolates, discharge disposition and adverse effects of Polymyxin B were recorded.ResultsA total of 44.8/1000(36/803) admitted patients developed MDR gram negative infections, of which 47.2%(17/36) were male, with mean age of 3.4 yrs(+/−4.16). Acinetobacter Species (25.5%) was the most frequently isolated MDR organisms followed by Klebsiella Pneumoniae (17%). Sensitivity of isolates was 100% to Polymyxin B, followed by Imipenem (50%), and piperacillin/tazobactem (45%). The crude mortality rate of patients with MDR gram negative infections was 44.4% (16/36). Fourteen of 36 patients received Polymyxin B and 57.1%; (8/14) of them were cured. Nephrotoxicity was observed in 21.4% (3/14) cases, none of the patients showed signs of neuropathy.ConclusionOur study highlights high rates of Carbapenem resistant gram negative isolates, leading to increasing use of Polymyxin B as the only drug to combat against these critically ill children. Therefore, we emphasizeon Stewardship of Antibiotics and continuous surveillance system as strategies in overall management of these critically ill children.

Highlights

Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care
As there is lack of data among pediatric age group especially in critically ill children, so we aim to describe the clinical characteristics, antibiotic sensitivity pattern and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms, and report the safety of polymyxin B use among critically ill pediatric patients
For respiratory secretions, all specimens were inoculated for quantitative culture, if identified 105 – 104 CFU/ml, gram staining was done followed by conventional biochemical test to identify specific gram negative organisms

Summary

Introduction

Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care. To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. Resistance to Imipenem for bloodstream isolates of Acinetobacter Baumannii from ICU patients has been reported to be as high as 85% [5]. Gram negative pathogens that are resistant to polymyxin are being reported from many countries and are a cause of mortality and high health care costs [8,9,10]. There has been a resurgence of old antibiotics such as polymyxin as last resort for the treatment of infections caused by MDR gram negative pathogens [12,13,14,15]

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