A study on the prevalence and drug resistance of bloodstream infections in intensive care unit in a children's medical center in eastern China: from 2016 to 2021

Abstract It is important to analyze the pathogen distribution and drug resistance of critically ill children with bloodstream infection (BSI) to help clinicians choose the appropriate empirical antibiotic therapy for clinical infection control. In the study, 281 critically ill children with BSI were retrospectively analyzed. A total of 328 strains were detected, including gram-positive bacteria (223, 67.99%), mainly including coagulase-negative staphylococci (CNS), gram-negative bacteria (91, 27.74%), fungi (14, 4.27%). There were 243 cases of single pathogen infection and 38 cases of mixed pathogen infection. Mixed infection can prolong the hospitalization time of patients. There were significant differences between the death group and the survival group in age, lengths of hospital stay, types of pathogenic bacteria and basic diseases (P<0.05). Compared with CNS, Staphylococcus aureus had lower resistance rates to some β-lactamides and sulfonamides antibiotics. The resistance rate of Streptococcus pneumoniae to macrolide was more than 95%. Enterococcus faecium had a high resistance rate to penicillin. Compared with Escherichia coli, the proportion of extended-spectrum β-lactamases (ESBLs) was higher producing by Klebsiella pneumoniae, and its resistance to some β-lactamides, quinolones antibiotics were lower. The resistance rates of Acinetobacter baumannii to various antibiotics were higher than 75%, but the resistance rates to levofloxacin and minocycline were low. Pseudomonas aeruginosawas 100% sensitive to some quinolones and aminoglycosides antibiotics. A total of 27 common multi-drug resistant (MDR) bacteria were detected, among which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for the highest proportion (13, 48.15%). CNS was the principal pathogen of BSI in the ICU of children, and Escherichia coli was the most common gram-negative pathogen. Low age group, long or short lengths of hospital stay, gram-positive and negative pathogen infection and serious basic diseases were the risk factors leading to the death of patients. It is necessary to continuously monitor patients with positive blood culture, pay special attention to the detected MDR bacteria, and strengthen the application management of antibiotics and the prevention and control of nosocomial infection.