Study objectives: To determine the magnitude of
infection rate and antimicrobial resistance in a pediatric ICU (PICU),
and to evaluate the efficacy of using broad-spectrum antibiotics.
Design: A 3-month, prospective, observational cohort
Setting: A 12-bed tertiary, referral PICU.
Patients or participants: All children admitted to the PICU
for > 72 h.
cultures of throat and rectum on admission and once weekly
Measurements and results: Of the 150
admissions during the 3-month period, a total of 52 patients (24 girls
and 28 boys) requiring mechanical ventilation for a minimum of 3 days
were enrolled in the audit. The median age and interquartile range
(IQR) was 17 months (IQR, 5.8 to 63); length of stay, 6.5 days (IQR, 4
to 13); ventilation days, 5 (IQR, 3 to 11); pediatric risk of mortality
score, 14 (IQR, 9 to 19); and risk of mortality, 0.03 (IQR, 0.014 to
0.087). Fifteen patients (29%) developed 21 infections, mainly
lower-airway infections and septicemias. Of the 52 children, 7 children
carried multidrug-resistant bacteria and 3 patients progressed to
develop four infections with those resistant bacteria. Of the seven
carriers, six patients carried gentamicin-resistant Klebsiella.
Methicillin-resistant Staphylococcus aureus,
penicillin-resistant Streptococcus pneumoniae and
gentamicin-resistant Pseudomonas aeruginosa each were
carried by one child. Six of those nine resistant isolates were present
in the admission flora. Despite the potent combination of
piperacillin/tazobactam and amikacin, three children acquired the
multidrug-resistant Klebsiella while in the PICU and became nosocomial
Conclusions: Only surveillance
cultures allow the distinction between import of multidrug-resistance
and resistant bacteria acquired while in PICU. In this study, two
thirds of the resistant isolates were imported. The introduction of
newer potent systemic antibiotic combinations failed to control the
endemic reservoir of multidrug-resistant Klebsiella and suggests that
such policies have little impact.