Characteristics and Risk Factor of Multidrug-Resistant-Organism Infection in the Pediatric Intensive Care Unit of Dr. Kariadi Hospital Semarang

Authors

  • Nahwa Arkhaesi Department of Pediatric, Medical Faculty of Diponegoro University/dr. Kariadi Hospital Semarang, Indonesia, Indonesia
  • Moh. Supriatna Department of Pediatric, Medical Faculty of Diponegoro University/dr. Kariadi Hospital Semarang, Indonesia, Indonesia
  • Yusrina Istanti Department of Pediatric, Medical Faculty of Diponegoro University/dr. Kariadi Hospital Semarang, Indonesia, Indonesia
  • Desvita Sari Department of Clinical Microbiology, Medical Faculty of Diponegoro University/ dr. Kariadi Hospital Semarang, Indonesia, Indonesia
  • Safira Rizqi Azzahra Medical Faculty of Diponegoro University, Semarang, Indonesia, Indonesia

DOI:

https://doi.org/10.36408/mhjcm.v11i1.989

Keywords:

risk factor, Culture, MDRO, PICU, antibiotic resistance

Abstract

BACKGROUND: The Pediatric Intensive Care Unit (PICU) that treats critical patients with various invasive procedures is a potential place for Multidrug Resistant Organism (MDRO) infections. This spesific unit, especially in tertiary care facilities may have higher prevalence of MDRO than non-PICU settings, causes serious disease and mortality. AIMS: To describe the characteristics and risk factor of MDRO infection in the PICU of dr. Kariadi Hospital Semarang, METHOD: Retrospective study in patients aged 1 month - 18 years with growth of germs on culture results during 2021-2022. Demographic data, use of central venous catheters and ventilator, length of stay, duration of antibiotic usage, and history of major surgery were investigated from medical records. The amount of risk expressed by the Odds Ratio (OR).RESULT: From 544 culture examinations, 199 (36.5%) germs grew, consisting of 79 MDRO isolates (39.7%) and 120 non-MDRO isolates (60.3%). Gram-negative bacteria were found in 140 samples (70.4%) with Klebsiella pneumoniae as the most common germ (15.1%) and respiratory tract infection (56.3%) being the most common infection diagnosis. As many as 24 of 30 (80%) isolates that grew Klebsiella pneumoniae were MDRO. Mechanical ventilator use (OR 2.15; 95% CI 1.07 – 4.3; p=0.043) and length of stay in the PICU (OR 2.44; 95% CI 1.21 – 4.96; p=0.018) are risk factors for MDRO infection.CONCLUSION: Klebsiella pneumoniae is the most common germ found from culture isolates and respiratory tract infection is the most common diagnosis. The use of mechanical ventilators and length of stay in the PICU are risk factors for MDRO infection. 

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References

1. Hauhnar L, Pachuau L, Lalhruaitluanga H. Isolation and characterization of multi-drug resistant bacteria from hospital wastewater sites around the city of Aizawl, Mizoram. Advances in Bioscience and Biotechnology. 2018;9(07):311.

2. Serra-Burriel M, Keys M, Campillo-Artero C, Agodi A, Barchitta M, Gikas A, et al. Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLoS One. 2020;15(1):e0227139.

3. Reygaert WC. An Overview of the Antimicrobial Resistance Mechanisms of Bacteria. AIMS Microbiol. 2018;4(3):482–501.

4. Siegel JD, Rhinehart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007;35(10):S165–93.

5. Liu C, Yoon E, Kim D, Shin J, Shin J, Shin K, et al. Antimicrobial resistance in South Korea: A report from the Korean global antimicrobial resistance surveillance system (Kor-GLASS) for 2017. Journal of Infection and Chemotherapy. 2019;25(11):845–59.

6. Resistance FA. Protect Mothers and Newborns. In: 4th Global Conference of Women Deliver; WHO Regional Office for Europe: Copenhagen, Denmark. 2016.

7. Siahaan S, Herman MJ, Fitri N. Antimicrobial resistance situation in Indonesia: A challenge of multisector and global coordination. J Trop Med. 2022;2022.

8. Manusia KKBP. Peraturan Menteri Koordinator Bidang Pembangunan Manusia dan Kebudayaan Republik Indonesia No. 2 Tahun 2017 Tentang Rencana Strategis Kementerian Koordinator Bidang Pembangunan Manusia dan Kebudayaan Tahun 2015-2019. diakses dari https://www. kemenkopmk. go. id/sites/default/files/produkhukum. PERMENKO% 20RENSTRA pdf. 2019;27.

9. Edae G, Tekleab AM, Getachew M, Bacha T. Admission Pattern and Treatment Outcome in Pediatric Intensive Care Unit, Tertiary Hospital, Addis Ababa, Ethiopia. Ethiop J Health Sci. 2022;32(3).

10. Wattal C, Kler N, Oberoi JK, Fursule A, Kumar A, Thakur A. Neonatal sepsis: mortality and morbidity in neonatal sepsis due to multidrug-resistant (MDR) organisms: part 1. The Indian Journal of Pediatrics. 2020;87:117–21.

11. Moustafa AA, Raouf MM, El-Dawy MS. Bacterial healthcare-associated infection rates among children admitted to Pediatric Intensive Care Unit of a Tertiary Care Hospital, Egypt. Alexandria Journal of Pediatrics. 2017;30(3):100.

12. Chen X, Pan D, Chen Y. The drug resistance of multidrug-resistant bacterial organisms in pediatric pneumonia patients. Am J Transl Res. 2021;13(4):3309.

13. Chan YQ, Chen K, Chua GT, Wu P, Tung KTS, Tsang HW, et al. Risk factors for carriage of antimicrobial-resistant bacteria in community dwelling-children in the Asia-Pacific region: a systematic review and meta-analysis. JAC Antimicrob Resist. 2022;4(2):dlac036.

14. Rezk AR, Bawady SA, Omar NN. Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care. Egyptian Pediatric Association Gazette. 2021;69(1):1–9.

15. Alebel M, Mekonnen F, Mulu W. Extended-spectrum β-lactamase and carbapenemase producing gram-negative bacilli infections among patients in intensive care units of felegehiwot referral hospital: a prospective cross-sectional study. Infect Drug Resist. 2021;391–405.

16. Alhumaid S, Al Mutair A, Al Alawi Z, Alzahrani AJ, Tobaiqy M, Alresasi AM, et al. Antimicrobial susceptibility of gram-positive and gram-negative bacteria: a 5-year retrospective analysis at a multi-hospital healthcare system in Saudi Arabia. Ann Clin Microbiol Antimicrob. 2021;20(1):43.

17. Li J yang, Chen S qin, Yan Y yan, Hu Y ying, Wei J, Wu Q ping, et al. Identification and antimicrobial resistance of pathogens in neonatal septicemia in China—A meta-analysis. International Journal of Infectious Diseases. 2018;71:89–93.

18. Remschmidt C, Schneider S, Meyer E, Schroeren-Boersch B, Gastmeier P, Schwab F. Surveillance of antibiotic use and resistance in intensive care units (SARI): a 15-year cohort study. Dtsch Arztebl Int. 2017;114(50):858.

19. Cetin BS, Şahin A, Kürkçü CA, Küçük F, Sağıroğlu P, Akyıldız BN. Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit: Bacteriological Profile and Antimicrobial Resistance in PICU. The Journal of Pediatric Academy. 2022;3(2):78–84.

20. Putra IW, Setyaningtyas A, Puspitasari D, Wahyu AD, Dharmawati I, Azis AL. Microbial pattern and antibiotic susceptibility in pediatric intensive care unit Dr. Soetomo hospital, Surabaya. Indonesian Journal of Tropical and Infectious Disease. 2019;7(5):122–30.

21. Odari R, Dawadi P. Prevalence of multidrug-resistant Klebsiella pneumoniae clinical isolates in Nepal. J Trop Med. 2022;2022.

22. Virawan H, Nuryastuti T, Nirwati H. Multidrug-resistant Klebsiella pneumoniae from clinical isolates at dr. Soeradji Tirtonegoro central hospital Klaten. JKKI: Jurnal Kedokteran dan Kesehatan Indonesia. 2020;109–20.

23. Chang D, Sharma L, Dela Cruz CS, Zhang D. Clinical epidemiology, risk factors, and control strategies of Klebsiella pneumoniae infection. Front Microbiol. 2021;3955.

24. Paczosa MK, Mecsas J. Klebsiella pneumoniae: going on the offense with a strong defense. Microbiology and molecular biology reviews. 2016;80(3):629–61.

25. Ochońska D, Ścibik Ł, Brzychczy-Włoch M. Biofilm formation of clinical Klebsiella pneumoniae strains isolated from tracheostomy tubes and their association with antimicrobial resistance, virulence and genetic diversity. Pathogens. 2021;10(10):1345.

26. Wu D, Ding Y, Yao K, Gao W, Wang Y. Antimicrobial resistance analysis of clinical Escherichia coli isolates in neonatal ward. Front Pediatr. 2021;9:670470.

27. Będzichowska A, Przekora J, Stapińska-Syniec A, Guzek A, Murawski P, Jobs K, et al. Frequency of infections caused by ESBL-producing bacteria in pediatric ward–single center five-year observation. Archives of Medical Science. 2019;15(3):688–93.

28. Kayastha K, Dhungel B, Karki S, Adhikari B, Banjara MR, Rijal KR, et al. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in pediatric patients visiting International Friendship Children’s Hospital, Kathmandu, Nepal. Infectious Diseases: Research and Treatment. 2020;13:1178633720909798.

29. Zagaglia C, Ammendolia MG, Maurizi L, Nicoletti M, Longhi C. Urinary Tract Infections Caused by Uropathogenic Escherichia coli Strains—New Strategies for an Old Pathogen. Microorganisms. 2022;10(7):1425.

30. Ergül AB, Işık H, Altıntop YA, Torun YA. A retrospective evaluation of blood cultures in a pediatric intensive care unit: a three year evaluation. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 2017;52(3):154.

31. Wang Z, Xia Z. What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study. Ital J Pediatr. 2020;46:1–6.

32. Feeney ME, Lindsey DE, Vazquez DE, Porter K, Murphy C V. A Risk Factor Analysis for MRSA Ventilator-Associated Pneumonia to Guide Empiric Therapy in the Surgical Intensive Care Unit. J Infect Dis Epidemiol. 2019;5:075.

33. Qureshi S, Maria N, Zeeshan M, Irfan S, Qamar FN. Prevalence and risk factors associated with multi-drug resistant organisms (MDRO) carriage among pediatric patients at the time of admission in a tertiary care hospital of a developing country. A cross-sectional study. BMC Infect Dis. 2021;21(1):1–9.

34. Oishi T, Saito A, Fukuda Y, Kato A, Kondo E, Teranishi H, et al. Analysis of risk factors for multidrug-resistant pathogens and appropriate treatment indications for pneumonia in children with neurologic impairment. Journal of Infection and Chemotherapy. 2021;27(2):342–7.

35. Murray MT, Beauchemin MP, Neu N, Larson EL. Prior antibiotic use and acquisition of multidrug-resistant organisms in hospitalized children: a systematic review. Infect Control Hosp Epidemiol. 2019;40(10):1107–15.

36. Yusef D, Shalakhti T, Awad S, Algharaibeh H, Khasawneh W. Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: a retrospective review. Pediatr Neonatol. 2018;59(1):35–41.

37. Verma A, Vimalesvaran S, Dhawan A. Epidemiology, risk factors and outcome due to multidrug resistant organisms in paediatric liver transplant patients in the era of antimicrobial stewardship and screening. Antibiotics. 2022;11(3):387.

38. Tauran PM, Djaharuddin I, Bahrun U, Nurulita A, Katu S, Muchtar F, et al. Excess mortality attributable to antimicrobial-resistant bacterial bloodstream infection at a tertiary-care hospital in Indonesia. PLOS Global Public Health. 2022;2(7):e0000830.

 

Additional Files

Published

2024-03-28

How to Cite

1.
Arkhaesi N, Supriatna M, Istanti Y, Sari D, Azzahra SR. Characteristics and Risk Factor of Multidrug-Resistant-Organism Infection in the Pediatric Intensive Care Unit of Dr. Kariadi Hospital Semarang. Medica Hospitalia J. Clin. Med. [Internet]. 2024 Mar. 28 [cited 2024 Dec. 22];11(1):45-52. Available from: http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/989

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