Colonization by Multidrug Resistant Gram-Negative Bacilli: is it a matter for hospitalized children?

Resumo

Background and Objective: The colonization of skin and mucosa by multidrug resistant gram-negative bacilli (MR GNB) in hospitalized patients has received increasing attention. Methods: We evaluated the colonization by MR GNB to determine the MR GNB antimicrobial susceptibility profile and resistant genes in a paediatric population. A case-control study was carried out, patients considered colonized by MR GNB and patients non-colonized by MR GNB were evaluated. The variables that were compared between the groups were infection, central venous catheter, lung mechanical ventilation, long-term urinary catheter, and outcome. The sensitivity of the bacteria to the antimicrobial agents was analysed by the disc-diffusion technique, and the genetic diversity of the isolates was analysed by enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction (ERIC-PCR). Results: Patients with infection had 4 times greater odds of being colonized by MR GNB than non-infected patients. Among children colonized by MR GNB, the presence of an invasive procedure increased the odds of infection by 15 times. In children who were not colonized by MR GNB, the presence of an invasive procedure increased the odds of infection by 4 times. Among the 20 strains of MR GNB analysed, lower resistance was found for carbapenem and amikacin. The most common resistance mechanism was the production of CTXM1 enzymes, followed by CTXM15 and SHV. Conclusions: Colonization by MR GNB was associated with infection in paediatric patients; therefore, measures should be taken to prevent colonization by MR GNB. Consequently, knowing the state of bacterial colonization is still important in pediatric wards.