Increased Rate of Multidrug-Resistant Gram-Negative Bacterial Infections in Hospitalized Immunocompromised Pediatric Patients

Authors

• Sarah Khafaja
• Yara Salameh
• Celina F Boutros
• Cherine Awad
• Kawthar Faour
• Nadim Tfaily
• Sarah Merhi
• Zeinab El Zein
• Samer Bou Karroum
• Dana Oweini
• Danielle Fayad
• George F Araj
• Ramia Zakhour
• Ghassan S Dbaibo

Language

English

Publication Date

1-1-2024

Journal

Frontiers in Cellular and Infection Microbiology

DOI

10.3389/fcimb.2024.1382500

PMID

39835279

PMCID

PMC11743943

PubMedCentral® Posted Date

1-6-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Introduction: Multidrug resistant Gram-negative bacterial infections are considered a major public health threat. Immunocompromised pediatric patients are at a great risk of severe or overwhelming infections. The aim of this study was to describe the frequency of infections with multidrug resistant (MDR) Gram-negative bacteria (GNB) in immunocompromised pediatric patients and to determine the risk factors. In addition, we aimed to identify the antimicrobial resistance patterns of these isolates.

Materials and methods: This was a retrospective observational study conducted at the American University of Beirut Medical Center (AUBMC) from 2009 to 2017. The study included immunocompromised patients 18 years of age or younger with infections caused by Gram-negative bacteria isolated from a sterile site, or nonsterile site in the setting of clinical infection.

Results: A total of 381 episodes of infection with GNB in 242 immunocompromised pediatric patients were identified. The mean age was 7.7 years. The most common pathogens were Enterobacterales followed by Pseudomonas and Acinetobacter spp. MDR GNB infections predominated causing 72% of the episodes, with alarming MDR rates among Escherichia coli (95.7%) and Klebsiella pneumoniae (82.7%). The overall rate of MDR GNB isolated increased from 62.7% in 2015 to 90% in 2017. Thrombocytopenia, chemotherapy and previous colonization or infection with the same organism during the past 12 months were found to be independent risk factors for infection with MDR GNB.

Conclusion: This study provides data on the epidemiology of infections with MDR GNB in immunocompromised pediatric patients and illustrates the alarmingly high prevalence of these infections. This necessitates the frequent revisiting of treatment guidelines in these high-risk patients and the implementation of judicious antimicrobial stewardship programs and infection control policies to stabilize or decrease the prevalence of these infections.

Keywords

Humans, Immunocompromised Host, Gram-Negative Bacterial Infections, Child, Retrospective Studies, Drug Resistance, Multiple, Bacterial, Male, Female, Child, Preschool, Adolescent, Gram-Negative Bacteria, Infant, Anti-Bacterial Agents, Risk Factors, Hospitalization, Microbial Sensitivity Tests, multidrug resistance, gram-negative bacteria, antimicrobial resistance, immunocompromised, children, adolescent, cancer, inborn errors of immunity

Published Open-Access

yes

Recommended Citation

Khafaja, Sarah; Salameh, Yara; Boutros, Celina F; et al., "Increased Rate of Multidrug-Resistant Gram-Negative Bacterial Infections in Hospitalized Immunocompromised Pediatric Patients" (2024). Faculty, Staff and Student Publications. 4295.
https://digitalcommons.library.tmc.edu/uthmed_docs/4295