Surveillance of Multidrug-Resistant Organisms and Trends in Antimicrobial Susceptibility in Chronically Hospitalized Pediatric Patients
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Background Patients in long-term care facilities experience greater risk of infections, along with use of long-lasting invasive devices and colonization of multidrug resistant organisms. This study aims to analyze surveillance and clinical specimen culture results and trends in antimicrobial susceptibility among long-term hospitalized pediatric patients. Materials and Methods Data were collected retrospectively from January 2015 to December 2024 from a long-term care facility dedicated to children with chronic underlying diseases. All hospitalized patients that underwent clinical specimen collection as part of infection surveillance or clinical evaluation were included. Results From 2015 to 2024, 759 admissions (357 new, 402 readmissions) were recorded, and 4,623 clinical specimens were collected. A total of 216 bacterial isolates were identified (4.7% positivity rate) from 130 medically complex pediatric patients, 98.8% of whom were bedridden. Between 2019 and 2024, 14 bloodstream infection (BSI) episodes occurred in 12 patients, with 85.7% suspected to be catheter-related. The BSI isolation rate was 0.21 per 1,000 resident-days, and the BSI-attributable mortality rate was 14.3%. From 2016 to 2024, methicillin-resistant Staphylococcus aureus (MRSA) nasal/sputum positivity increased from 3.5% to 5.9%, and the MRSA isolation rate rose significantly from 0.128 to 0.367 per 1,000 resident-days (P=0.009). Rectal carbapenem-resistant Enterobacteriaceae (CRE) positivity increased significantly from 0% to 3.4% (P=0.004), with isolation rates rising from 0 to 0.149 per 1,000 resident-days (P=0.012). Conclusion This 10-year study highlights a low incidence of BSIs in a medically complex pediatric long-term care population, likely due to proactive infection control measures. However, rising trends in MRSA and CRE colonization underscore the need for continued surveillance and the development of pediatric-specific infection prevention strategies.
Abstract
Background Patients in long-term care facilities experience greater risk of infections, along with use of long-lasting invasive devices and colonization of multidrug resistant organisms. This study aims to analyze surveillance and clinical specimen culture results and trends in antimicrobial susceptibility among long-term hospitalized pediatric patients. Materials and Methods Data were collected retrospectively from January 2015 to December 2024 from a long-term care facility dedicated to children with chronic underlying diseases. All hospitalized patients that underwent clinical specimen collection as part of infection surveillance or clinical evaluation were included. Results From 2015 to 2024, 759 admissions (357 new, 402 readmissions) were recorded, and 4,623 clinical specimens were collected. A total of 216 bacterial isolates were identified (4.7% positivity rate) from 130 medically complex pediatric patients, 98.8% of whom were bedridden. Between 2019 and 2024, 14 bloodstream infection (BSI) episodes occurred in 12 patients, with 85.7% suspected to be catheter-related. The BSI isolation rate was 0.21 per 1,000 resident-days, and the BSI-attributable mortality rate was 14.3%. From 2016 to 2024, methicillin-resistant Staphylococcus aureus (MRSA) nasal/sputum positivity increased from 3.5% to 5.9%, and the MRSA isolation rate rose significantly from 0.128 to 0.367 per 1,000 resident-days (P=0.009). Rectal carbapenem-resistant Enterobacteriaceae (CRE) positivity increased significantly from 0% to 3.4% (P=0.004), with isolation rates rising from 0 to 0.149 per 1,000 resident-days (P=0.012). Conclusion This 10-year study highlights a low incidence of BSIs in a medically complex pediatric long-term care population, likely due to proactive infection control measures. However, rising trends in MRSA and CRE colonization underscore the need for continued surveillance and the development of pediatric-specific infection prevention strategies.