| Abstract |
Background
Antimicrobial resistance (AMR) has been characterized by the World Health Organization (WHO) as one of the greatest modern threats to humans in the field of Health, with increased influence both in terms of human resources and of the economy. The effect of AMR is maximum in healthcare-providing facilities and especially in hospitals, where increased rates of hospital-acquired infections (HAIs) are recorded. Within the hospital unit, the areas associated with increased rates of HAIs and AMR are the Intensive Care Units (ICUs). This is explained by the particularities of patients hospitalized in the ICU, as they are critically-ill and require immediate diagnostic and therapeutic interventions (use of indwelling devices), while the use of advanced antibiotics for their treatment is common. In Pediatric ICUs (PICUs), the difficulties of dealing with HAIs are greater due to the immaturity of the immune system of the pediatric population. The need for the surveillance of AMR is currently a key issue for PICUs as it depicts the quality of health services of each ICU.
Objective
The purpose of this study is to investigate and analyze the pathogenic microorganisms isolated from cultures of biological material and catheters of critically-ill children as well as the longitudinal evolution of microbial resistance in the PICU of the University General Hospital of Heraklion for the period 2008-2019.
Methods
It is a retrospective single-center study. The data collection was based on Hospital Infections Committee’s archives. Gram (+), Gram (-) microorganisms and fungi were examined individually. The data relating to the fungi was recorded for the period 2011-2019. The antibiotic markers for the monitoring of AMR were established on the basis of the protocol on the monitoring of HAIs in the ICU of the European Center for Disease Control and Prevention (ECDC). Gram (-) microorganisms were examined in terms of multi-resistance. In addition, basic resistance mechanisms of Enterobacteriaceae recorded by the Microbiological Laboratory of the University General Hospital of Heraklion were examined. Results
Of the total of 2,127 positive cultures collected, 1,598 were analyzed (529 duplicates). Positive cultures of biological material and catheters are mentioned in order of frequency: Gram (-) microorganisms (60.8%), Gram (+) microorganisms (29.7%) and fungi (9.5%). The prevalence of Gram (-) microorganisms was longitudinal. Positive cultures of biological material and catheters with Gram (+) microorganisms are reported in order of frequency: Coagulase-negative staphylococci (CoNS) (58.9%), Staphylococcus aureus (16.2%), Enterococcus spp. (15.6%) and other Gram (+) pathogens (9.3%). CoNS were more often isolated from blood cultures (62.9%) and S. aureus from bronchial secretions (59.7%) (p<0.001). The average resistance rate of methicillin-resistant S. aureus (MRSA) longitudinally was 40%. No positive trend of resistance was observed for Gram (+) microorganisms in any class of antibiotics. The isolation frequencies of Gram (-) were: Pseudomonas aeruginosa (37.6%), Enterobacteriaceae (31.1%), Acinetobacter baumannii (17.2%), Stenotrophomonas maltophilia (13.4%) and anaerobic Gram (-) microorganisms (0.8%). The majority of Gram (-) was isolated from bronchial secretions (68%). The longitudinal mean resistance of P.aeruginosa was 49% to carbapenems and 15% to ceftazidime, A.baummannii 64% to carbapenems, 60% to 3rd generation cephalosporins (C3G) and 11% to colistin, E.coli and Klebsiella spp. 23% and 32% to C3G, respectively, and S.maltophilia 53% to trimethoprim-sulfamethoxazole. No positive trend of resistance for Gram (-) pathogens was observed. The percentages of multi-resistant Gram (-) strains were: multidrug-resistant (MDR) 23.5%, extensively drug-resistant (XDR) 15.6%, pandrug-resistant (PDR) 1.2%. The most common resistance mechanism for E.coli and Klebsiella spp. was the production of extended-spectrum beta-lactamase (ESBL) (29% and 27%, respectively). The majority of fungi samples concerned non-albicans Candida species (58.9%). Over time antifungal resistance remained <3%.
Conclusion
In the PICU of the University General Hospital of Heraklion the prevailing microorganisms for the period 2008-2019 were the Gram (-) and their main representative was P.aeruginosa. Particularly increased resistance rates in most of the categories of antibiotics examined, were recorded for P.aeruginosa, A.baummannii and S.maltophilia. In addition, high rates of MRSA were recorded. Despite the increased resistance rates recorded, no positive trend of resistance was observed over the years.
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