Bacteriologic Profile and Susceptibility Pattern of Mechanically - Ventilated Pediatric Patients with Pneumonia.

PURPOSE: Therapy of severe pneumonia is very challenging in view of the current widespread bacterial resistance to many antibiotics especially extended spectrum ß-lactams, carbapenems, and anti-pseudomonal drugs. The current study aimed at assessing antimicrobial sensitivity pattern and optimization of the antibiotic stewardship program applied in a university affiliated pediatric intensive care unit (PICU).

SUBJECTS AND METHODS: This prospective cohort study included all patients aged 1 month to 12 years, admitted to the PICU with severe pneumonia episodes indicated for mechanical ventilation, and were followed up and investigated. Non-bronchoscopic bronchoalveolar lavage specimens were tested for positive microbiological yields and examined for their susceptibility pattern.

RESULTS: Eighty five patients with 96 episodes 69 of them yielded positive growth: 42 Community acquired pneumonia episodes, 62.79% of which were of unidentified cause, while bacteria isolated were predominantly due to Chlamydia pneumonia (18.6%) followed by Staph. Aureus (9.3%). Hospital and ventilator associated pneumonia were mainly related to gram negative bacteria (91.67%, and 87.8% respectively) especially Klebsiella, Acinetobacter, and Pseudomonas. There was a significant increase of multidrug resistance among gram negative bacteria which was considered an independent risk factor of mortality (p=0.003).

CONCLUSION: Severe community acquired pneumonia was treated with macrolides in combination with vancomycin or linezolid if methicillin resistant staph. aureus was suspected. This is appropriate in view of its causative agents and their susceptibility pattern. Hospital and ventilator associated pneumonia caused by resistant gram negative organisms, might give better outcome on adding tigecycline or colistin in combination to fluroquinolones. Owing to the widespread resistance of many gram negative bacteria, it is recommended to frequently update the antibiotic stewardship program.