Download PDF
J Pediatr Intensive Care
DOI: 10.1055/s-0043-1772818
Original Article

Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Gram-Negative Bacteria in a Pediatric Intensive Care Unit

Melis Deniz 
1   Department of Pediatric Infectious Diseases, Sanlıurfa Training and Research Hospital, Sanlıurfa, Türkiye
,
Hande Şenol
2   Department of Bioistatistics, Pamukkale University, Denizli, Türkiye
,
Tugba Erat
3   Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Türkiye
,
Hatice Feray Arı
4   Department of Pediatric Intensive Care Unit, Sanlıurfa Training and Research Hospital, Sanlıurfa, Türkiye
,
Ümit Altug
5   Department of Pediatric Intensive Care Unit, Pamukkale University, Denizli, Türkiye
,
Eylem Kıral
6   Department of Pediatric Intensive Care Unit, Osmangazi University, Eskişehir, Türkiye
,
Kerim Parlak
7   Department of Microbiology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Türkiye
,
Hadice Özçınar
7   Department of Microbiology, Sanlıurfa Training and Research Hospital, Sanlıurfa, Türkiye
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

We aimed to analyze risk factors of ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR), pan-drug-resistant (PDR), and extensively drug-resistant (XDR) gram-negative bacteria (GNB) in a pediatric intensive care unit (PICU). This retrospective study evaluated pediatric patients diagnosed with VAP at a tertiary referral hospital. Of the 46 children in the present study, 40 (86.9%) had VAP caused by MDR-, XDR-, and PDR-GNB. Most patients (60.9%) had spent >28 days in the PICU at the time of diagnosis. Respiratory failure necessitating PICU admission was associated with XDR infection-induced VAP (p = 0.034). High rates of prior broad-spectrum antibiotic use were observed in patients with XDR GNB-induced VAP. VAP induced by MDR-, XDR-, and PDR-GNB occurred more frequently than that caused by drug-susceptible GNB in PICU patients. Long stays for more than 28 days in the PICU and past use of broad-spectrum antibiotics can lead to the development of XDR-GNB-induced VAP. The high antibiotic resistance rates detected in our study highlight the importance of strict infection control measures and antimicrobial stewardship programs in PICUs.

Keywords

ventilator-associated pneumonia - pediatric intensive care unit - antibiotic resistance - antimicrobial stewardship - carbapenem-resistant


Publication History

Received: 06 May 2023

Accepted: 25 July 2023

Article published online:
28 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kumar V. Ventilator associated pneumonia in children: current status and future prospects. Indian J Pediatr 2018; 85 (10) 830-831
    CrossrefPubMedGoogle Scholar
  • 2 Chang I, Schibler A. Ventilator associated pneumonia in children. Paediatr Respir Rev 2016; 20: 10-16
    PubMedGoogle Scholar
  • 3 Patria MF, Chidini G, Ughi L. et al. Ventilator-associated pneumonia in an Italian pediatric intensive care unit: a prospective study. World J Pediatr 2013; 9 (04) 365-368
    CrossrefPubMedGoogle Scholar
  • 4 Vijay G, Mandal A, Sankar J, Kapil A, Lodha R, Kabra SK. Ventilator associated pneumonia in pediatric intensive care unit: incidence, risk factors and etiological agents. Indian J Pediatr 2018; 85 (10) 861-866
    CrossrefPubMedGoogle Scholar
  • 5 Royer S, Faria AL, Seki LM. et al. Spread of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clones in patients with ventilator-associated pneumonia in an adult intensive care unit at a university hospital. Braz J Infect Dis 2015; 19 (04) 350-357
    CrossrefPubMedGoogle Scholar
  • 6 Kara SS, Polat M, Tapisiz A, Kalkan G, Simsek H, Tezer H. Ventilator associated pneumonia due to carbapenem resistant microorganisms in children. Minerva Pediatr 2019; 71 (04) 349-357
    PubMedGoogle Scholar
  • 7 Inchai J, Liwsrisakun C, Theerakittikul T, Chaiwarith R, Khositsakulchai W, Pothirat C. Risk factors of multidrug-resistant, extensively drug-resistant and pandrug-resistant Acinetobacter baumannii ventilator-associated pneumonia in a Medical Intensive Care Unit of University Hospital in Thailand. J Infect Chemother 2015; 21 (08) 570-574
    CrossrefPubMedGoogle Scholar
  • 8 National healthcare-associated infections surveillance guideline, Ankara 2017. Accessed on October 14, 2022
    PubMed
  • 9 The European Committee on Antimicrobial Susceptibility Testing. Clinical breakpoints - breakpoints and guidance. Accessed on February 14, 2023 at: https://www.eucast.org/clinical_breakpoints
    PubMed
  • 10 Magiorakos AP, Srinivasan A, Carey RB. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18 (03) 268-281
    CrossrefPubMedGoogle Scholar
  • 11 Patra PK, Jayashree M, Singhi S, Ray P, Saxena AK. Nosocomial pneumonia in a pediatric intensive care unit. Indian Pediatr 2007; 44 (07) 511-518
    PubMedGoogle Scholar
  • 12 Kumari P, Datta P, Gombar S, Sharma D, Chander J. Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India. Trop Doct 2021; 51 (02) 162-167
    CrossrefPubMedGoogle Scholar
  • 13 Hegazy EE, Bahey MG, Abo Hagar AM, Elkholy AA, Mohamed EA. Carbapenem-resistant gram-negative bacilli causing ventilator associated pneumonia: Study of MASTDISCS combi Carba plus for detection of carbapenemase producing enterobacterales. Infect Drug Resist 2022; 15: 6331-6342
    CrossrefPubMedGoogle Scholar
  • 14 Rezai MS, Ahangarkani F, Rafiei A, Hajalibeig A, Bagheri-Nesami M. Extended- spectrum beta-lactamases producing Pseudomonas aeruginosa isolated from patients with ventilator associated nosocomial infection. Arch Clin Infect Dis 2018;13(04):
    PubMedGoogle Scholar
  • 15 Chiotos K, Hayes M, Gerber JS, Tamma PD. Treatment of Carbapenem-resistant enterobacteriaceae infections in children. J Pediatric Infect Dis Soc 2020; 9 (01) 56-66
    CrossrefPubMedGoogle Scholar
  • 16 European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2022 (2020 data). Accessed on February 14, 2023 at: https://www.ecdc.europa.eu/sites/default/files/documents/ECDC-WHO-AMR-report.pdf
    PubMed
  • 17 Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America Guidance on the treatment of extended-spectrum β-lactamase producing enterobacterales (ESBL-E), carbapenem-resistant enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clin Infect Dis 2021; 72 (07) e169-e183
    CrossrefPubMedGoogle Scholar
  • 18 Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev 2007; 20 (03) 440-458
    CrossrefPubMedGoogle Scholar
  • 19 Albiger B, Glasner C, Struelens MJ, Grundmann H, Monnet DL. European Survey of Carbapenemase-Producing Enterobacteriaceae. (EuSCAPE) working group. Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries. Euro Surveill 2015;20(45 doi:
    PubMedGoogle Scholar
  • 20 Karaaslan A, Soysal A. Carbapenemases. J Pediatr Inf 2017; 11: 23-28
    CrossrefPubMedGoogle Scholar
  • 21 Teoli J, Amour S, Dananché C. et al. Trends in the proportion of resistant bacteria involved in ventilator-associated pneumonia as the first hospital-acquired infection in intensive care units between 2003 and 2016 in Lyon, France. Am J Infect Control 2021; 49 (11) 1454-1456
    CrossrefPubMedGoogle Scholar
  • 22 Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care 2005; 50 (06) 725-739 , discussion 739–741
    PubMedGoogle Scholar
  • 23 Liu B, Li SQ, Zhang SM. et al. Risk factors of ventilator-associated pneumonia in pediatric intensive care unit: a systematic review and meta-analysis. J Thorac Dis 2013; 5 (04) 525-531
    PubMedGoogle Scholar
  • 24 Čiginskienė A, Dambrauskienė A, Rello J, Adukauskienė D. Ventilator-associated pneumonia due to drug-resistant Acinetobacter baumannii: risk factors and mortality relation with resistance profiles, and independent predictors of in-hospital mortality. Medicina (Kaunas) 2019; 55 (02) 49
    CrossrefPubMedGoogle Scholar