A new metric of antibiotic class resistance in gram-negative bacilli isolated from hospitalized children.

OBJECTIVE

The purpose of this study was to describe patterns of infection or colonization with antibiotic-resistant gram-negative bacilli (GNB) in hospitalized children utilizing an electronic health record.

SETTING

Tertiary care facility.

PARTICIPANTS

Pediatric patients 18 years of age or younger hospitalized from January 1, 2006, to December 31, 2008.

METHODS

Children were identified who had (1) at least 1 positive culture for a multidrug-resistant (MDR) GNB, defined as a GNB with resistance to 3 or more antibiotic classes; or (2) additive drug resistance, defined as isolation of more than 1 GNB that collectively as a group demonstrated resistance to 3 or more antibiotic classes over the study period. Differences in clinical characteristics between the 2 groups were ascertained, including history of admissions and transfers, comorbid conditions, receipt of procedures, and antibiotic exposure.

RESULTS

Of 56,235 pediatric patients, 46 children were infected or colonized with an MDR GNB, of which 16 were resistant to 3 classes and 30 were resistant to 4 classes. Another 39 patients had positive cultures for GNB that exhibited additive drug resistance. Patients with additive drug resistance were more likely than patients with MDR GNB to have had previous admissions to a long-term facility (8 vs 2; P = .04) and had more mean admissions (7 vs 3; P < .01) and more mean antibiotic-days (P < .01 to P = .02). Six patients with additive drug resistance later had a positive culture with an MDR GNB.

CONCLUSIONS

An electronic health record can be used to track antibiotic class resistance in GNB isolated from hospitalized children over multiple cultures and hospitalizations.