Clinico-Epidemiologic Profile and with Multi Drug Resistant Gram-Negative Healthcare AssociatedOutcome of Pediatric Patients Infections at the Philippine General Hospital

Introduction: Multi Drug Resistant Organisms (MDRO) are microorganisms that are resistant to one or more classes of antimicrobial agents, and these have become significant pathogens to contend with in the treatment of Healthcare Associated Infections. Objectives: This study aimed to determine the clinico-epidemiologic profile and outcome of pediatric patients with healthcare-associated multi-drug resistant gram-negative infections, and its antimicrobial susceptibility patterns. Methodology: This was a retrospective study done on pediatric patients with gram negative healthcare associated MDRO sepsis compared to non-MDRO sepsis admitted at the ICU and pediatric wards of a tertiary government hospital from July 2015 to June 2016. Descriptive statistics was used to summarize the clinical characteristics of patients. Odds ratio and the corresponding 95% confidence interval from binary logistic regression was computed to determine significant predictors for the development of multi drug resistance. Outcome of patients with MDRO gram-negative infection was noted, as well as its antimicrobial susceptibility patterns. Results: A total of 199 patients developed HAI, and 41% were identified to be gram negative MDR cases. Pediatric patients with healthcare associated infections due to MDR gram negative organisms had shorter hospital stay and a higher mortality rate of 78% compared to 41% among non MDR patients.The most commonly isolated gram negative organisms were Burkholderia cepacia, 38%; Klebsiella pneumoniae, 31%; and Acinetobacter baumanii, 18%; while the most common MDR gram negative isolates were Klebsiella pneumoniae, 65%; Acinetobacter aumanii, 22%; and Pseudomonas aeruginosa, 7%. Significant predictors for MDRO were age (0-28 days old), ICU admission, intravascular catheterization and use of total parenteral nutrition. Conclusion: Profile of pediatric patients with healthcare-associated multidrug resistant gram-negative infections were neonates admitted in the ICU with a shorter hospital stay and a high mortality rate. The identified risk factors for developing Multi Drug Resistant Gram Negative sepsis were age of 0-28 days, admission to ICU, intravascular catheterization and parenteral nutrition. Patients with gram-negative MDR infections have a high mortality rate and isolates are susceptible mostly to Colistin.