Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia.
Medical Microbiology, Qunfudah Faculty of Medicine, Umm Al-Qura University, AL-Qunfudah, Saudi Arabia.
Medicine (Baltimore). 2023 Oct 20;102(42):e35638. doi: 10.1097/MD.0000000000035638.
Successful empirical antibiotic therapy for infected patients with multi drug resistant bacteria (MDR) can be challenging task in various healthcare settings, including neonatal and pediatric intensive care units (NICU and PICU, respectively), unless an up-to-date comprehensive local antibiogram data is available. Thus, this project aimed to investigate the prevalence of MDR among PICU and NICU patients as well as the identification of risk factors associated with recovered MDR bacteria. This was a retrospective study of PICU and NICU patients admitted with bacterial infection of MDR organisms between October 2020 and May 2021. Frequency distribution, Chi-square test were applied to verify the significance differences among subgroups and to identify risk factor associated with each group. About 36.4% of recruited patients were neonates, while the remaining percentage (63.6%) were pediatric. The most predominant site of infection among these patients were revealed as urinary tract (35%), followed by bloodstream (20.0%), wound/skin (12.9%) and respiratory system (11.4%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the most common microbe across these sites of infections (30.7%), followed by Escherichia coli (25.0%), Klebsiella pneumoniae (22.9%) and Serratia (10.0%). High mortality rate was significantly associated with patients who were on mechanical ventilators (28.9%, OR 5.5; 95% CI), followed by patients had invasive operation (27.5%, OR, 8.04; 95% CI) and those who required a total parental nutrition (TPN) since almost one-half of these cases have (46.2%) died. In addition, mortality rate was relatively higher among patients infected with species of Serratia (28.6%) and Enterobacter (20.0%). These data highlighted that MRSA was the main MDR bacteria isolated from PICU and NICU followed by gram-negative bacteria, which were associated with high mortality rate. Therefore, infection control measures and continuous monitoring of emerging MDR bacteria should be applied to limit the bacterial infections in NICU and PICU patients.
在各种医疗环境中，包括新生儿重症监护病房（NICU）和儿科重症监护病房（PICU），对于感染了多药耐药菌（MDR）的患者，成功进行经验性抗生素治疗可能是一项具有挑战性的任务，除非有最新的全面本地抗生素药敏谱数据。因此，本项目旨在调查 PICU 和 NICU 患者中 MDR 的流行情况，以及确定与恢复的 MDR 细菌相关的危险因素。这是一项回顾性研究，纳入了 2020 年 10 月至 2021 年 5 月期间因 MDR 菌引起细菌感染而入住 PICU 和 NICU 的患者。应用频率分布、卡方检验来验证亚组之间的显著性差异，并确定与每个组相关的危险因素。约 36.4%的入组患者为新生儿，其余 63.6%为儿科患者。这些患者中最主要的感染部位为尿路感染（35%），其次为血流感染（20.0%）、伤口/皮肤感染（12.9%）和呼吸系统感染（11.4%）。耐甲氧西林金黄色葡萄球菌（MRSA）是这些感染部位最常见的微生物（30.7%），其次是大肠杆菌（25.0%）、肺炎克雷伯菌（22.9%）和沙雷菌（10.0%）。高死亡率与使用机械通气的患者（28.9%，OR 5.5；95%CI）显著相关，其次是接受有创操作的患者（27.5%，OR 8.04；95%CI）和需要全胃肠外营养（TPN）的患者（因为近一半的患者死亡）。此外，感染沙雷菌（28.6%）和肠杆菌（20.0%）的患者死亡率相对较高。这些数据表明，MRSA 是从 PICU 和 NICU 分离出的主要 MDR 细菌，其次是革兰氏阴性菌，与高死亡率相关。因此，应采取感染控制措施和持续监测新出现的 MDR 细菌，以限制 NICU 和 PICU 患者的细菌感染。
