Introduction:

in recent years, there has been an increase in the identification of Multidrug Resistant Bacteria (MDRB) in pediatrics, regarding both colonization and infection, which has led to morbidity and mortality. Strict surveillance is carried out in the hospital to guide prevention measures and prevent the spread and intra-hospital contagion.

Objectives:

to describe the incidence, epidemiological and clinical characteristics of hospitalized children and adolescents to whom MDRB was identified through surveillance of infections associated with health care.

Material and methods:

observational, descriptive, retrospective study. We included children and adolescents admitted to a pediatric reference hospital to whom BMDR had been prescribed. Variables: epidemiological, clinical, microbiological and evolutionary. Statistical analysis: summary measures. Ethical research standards were guaranteed and colonization by BMDR was studied in children with stays of more than 10 days who came from closed areas outside the Pediatric Reference Hospital, the sample was swabbed rectal. Techniques for nucleic acid detection and culture were applied.

Results:

59 patients were identified, 56 colonizations and 3 infections, the first was a colonization by KPC in 2016. Since then, they increased to 18 in 2022 and 14 in July 2023. The average age was 9.1 months (range 15 days to 7 years). 32 female and 27 male. The patients came from all over the country, predominantly from the metropolitan area (15 Montevideo and 14 Canelones). 35 patients had comorbidities: 12 preterm, 2 transplanted, 8 congenital heart disease, 5 severe malnutrition with total parenteral nutrition, 2 under treatment with immunosuppressants and 1 hemato oncological. 37 patients received antibiotic therapy prior to MDRB detection (average 9 days). Regarding medical devices, 14 had orotracheal intubation, 6 had a central venous line, 3 had a tracheostomy, 3 had chest drainage, 1 had biliary drainage and 1 had a permanent implantable venous device. The diagnosis at discharge was respiratory infection in 45 cases, bronchiolitis was the most common in 29. 56 were admitted to intensive care, mean 11.6 days (range 1 to 90). Regarding agent identification, 57 samples were rectal swabs, 2 respiratory secretions and blood sample. We used PCR for rectal swab detection in 39 patients and culture in 18. For cases of infections: 1 blood culture and 2 cultures of respiratory secretions, then the resistance mechanism was identified by immunochromatographic tests. The most frequently identified bacteria were Klebsiella pneumoniae 9 and Pseudomonas aeruginosa 6. The distribution according to resistance mechanism was NDM 33, KPC 10, OXA-48 9, OXA-51 6, VIM 6, IMP 1, GES 1. In 3 cases we identified 2 carbapenemase. 6 patients died (2 infected and 4 colonized). 41 patients were discharged.

Conclusions:

through surveillance, an increase in the identification of MDRB was observed, especially in the past year. The presence of MDRB infection contributed to increased mortality. Timely identification is essential to prevent dissemination and to implement guideline prevention measures.

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