Isolated Pathogens, Antimicrobial Resistance Patterns and Associated Risk Factors Among Pediatric ICU Patients Beyond the Neonatal Age Group at Asella Teaching and Referral Hospital

Abstract

ABSTRACT Background: Antimicrobial resistance (AMR) is a global public health crisis. Pediatric intensive care units (PICUs) provide care for critically ill children who are at high risk for infections caused by multidrug-resistant (MDR) pathogens. Patients with infections caused by drug-resistant bacteria are at increased risk of worse clinical outcomes including death and increased health care cost. Objectives: To assess the isolated microbial pathogens, antimicrobial resistance patterns, and associated risk factors among PICU patients beyond the neonatal age group at Asella Teaching and Referral Hospital (ATRH). Method: A hospital-based cross-sectional study was conducted using medical records of children aged 29 days to 14 years admitted to the PICU of ATRH. Medical records of 217 patients meeting inclusion criteria were included. Data wase coded and entered in to EPI-INFO version 7.2.7.0 and analyzed by Statistical Package for Social Science (SPSS) version 27. In the binary logistic regression analysis odds ratios (OR), 95 % confidence intervals (CI) and P-values was used to determine factors associated with AMR. Variables with P <0.25 in the bivariate analysis was analyzed for multivariate logistic regression. A P-value of less than 0.05 will be considered statistically significant. Results: Among 217 pediatric ICU admissions, 114 (52.5%) had positive cultures, and 66 isolates underwent antimicrobial susceptibility testing. Coagulase-negative staphylococci were the most frequent isolated organisms, followed by Klebsiella and Enterobacter species. High-risk Antimicrobial resistance (AMR) was identified in 45 (68.2%) isolates. Prolonged PICU stay (>7 days) was independently associated with high-risk AMR (AOR = 7.59; 95% CI: 1.10–52.60). Mortality during PICU admission was also significantly associated with high-risk AMR (AOR = 8.22; 95% CI: 1.39–48.63). Conclusion: A high prevalence of high-risk antimicrobial resistance was observed among pediatric patients admitted to the PICU. The findings are consistent with Ethiopian hospital-based studies and WHO global surveillance reports. Prolonged length of stay in the PICU and death during PICU admission were significantly associated with high-risk antimicrobial resistance. These findings highlight the close relationship between hospitalization duration, disease severity, and high-risk antimicrobial resistance, and emphasize the need for targeted interventions in pediatric intensive care settings. Key words: Antimicrobial resistance, Pediatric ICU, Hospital-acquired infections, Asella, Ethiopia