Abstract
Bloodstream infections (BSI) due to multidrug-resistant organisms, especially from pediatric intensive care units (PICU), are being increasingly reported across the world. Since BSI is associated with high mortality, it is essential to treat these infections early with appropriate antibiotics. Surveillance of etiology and emerging antimicrobial resistance (AMR) is considered an important step in the formulation of antibiotic policy for early treatment and judicious use of antibiotics. In this review on etiology and its antibiogram in community acquired BSI, S. typhi followed by S. paratyphi A were the major bacterial isolates. Quinolone resistance of more than 90% in Salmonella is now reported from all over India. Ceftriaxone remains the drug of choice for enteric fever due to its 100% susceptibility. In PICU there is an emergence of candidemia due to non-albicans candida which are now predominant isolates at few centers. BSI due to gram-negative bacteria, mostly by Klebseilla pneumoniae and gram-positive cocci (S. aureus) are the other major pathogens commonly observed in BSI from PICU. There is a high prevalence of antimicrobial resistance to commonly used antibiotics like ampicillin (94.9%–90.7%), cefotaxime (92.4%–71.4%), piperacillin-tazobactum (31.2%–27.5%) and levofloxacin (42.4%–39.8%). Resistance to carbapenems, primarily due to blaNDM is seen in all the centers and the rate varies between 1%- 79% with K. pneumoniae and A. baumannii showing the maximum resistance. This review highlights the magnitude of the AMR in the pediatric population and calls for the urgent implementation of antimicrobial stewardship programs to save the remaining antimicrobials.
Highlights
Multi-drug-resistant (MDR) infections in the pediatric age group, especially due to gram-negative bacteria (GNB) are increasing world over with higher mortality [1]
Especially in pediatric intensive care units (PICU), for hospital-acquired infections (HAIs) are common for adults and children which include exposure to invasive devices including intravascular catheters, intubation, hyper-alimentation, and other comorbidities like immune-suppression
Information technology (IT) support is recognized as an essential important resource to generate reliable HAI surveillance data [6]
Summary
Multi-drug-resistant (MDR) infections in the pediatric age group, especially due to gram-negative bacteria (GNB) are increasing world over with higher mortality [1]. Overall mortality in Indian PICU due to hospital-acquired infections (HAIs) has been estimated to be 26%. Bloodstream infections (BSI) are considered as the most serious infections in pediatric intensive care units (PICU) and carry the highest mortality with an estimated attributable mortality of 3% and crude mortality of 18% [2, 3]. Especially in PICU, for HAIs are common for adults and children which include exposure to invasive devices including intravascular catheters, intubation, hyper-alimentation, and other comorbidities like immune-suppression.
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