Epidemic Characteristics Of Multi-Drug Resistant Organisms Infection And The Associated Factors For Its Hospital Acquired Infection In Pediatric Patients

Objective In recent years,Multi-drug resistant organisms(MDRO)have become an important concern in the monitoring and management of Hospital acquired infection(HAI)surveillance.This study intended to analyze the prevalence and characteristics of MDRO infection in pediatric patients in children’s hospitals for five consecutive years from 2017 to 2021,and to analyze the differences between the characteristics of HAI and Community acquired infection(CAI)cases in hospitalized children with MDRO infection,and the associated factors for MDRO-HAI in pediatric patients.So as to make the prevention and control of MDRO-HAI infection more evidence-based and accurate.Methods The only tertiary children’s specialist hospital in Anhui Province was selected as the research site.2,290 hospitalized children who tested positive for MDRO from2017 to 2021 were investigated.We collected data of pathogen species,department distribution,specimen type,detection rate and other characteristics of MDRO infection in hospitalized children during the five years.According to the source of MDRO infection,all hospitalized children with MDRO infection were divided into HAI group and CAI group to compare the differences in the distribution of relevant features between this two groups.Then according to whether it was caused by MDRO infection,3022 HAI cases that occurred in the the five years were divided into MDRO group and non-MDRO group,and multivariate logistic regression analysis was used to explore the associated factors for MDRO-HAI in hospitalized children.Results(1)The analysis results of MDRO infection characteristics in hospitalized children from 2017 to 2021 showed that 2290 hospitalized children with MDRO infection and 2350 MDRO strains were detected in a total of 322279 hospitalized children.Among them,there were 291 cases of MDRO-HAI and 1999 cases of MDRO-CAI.The rate of MDRO-HAI was 0.09%(291/322279).(2)The 2350 samples with MDRO were mainly from pus,urine,blood and sputum,of which pus accounted for the highest proportion that 651 samples were detected,accounting for 27.70%.In terms of composition ratio for pathogen species,the highest proportion was Extended-spectrum β-lactam,Escherichia coli(ESBLECO),accounting for 42.55% of the total detected;followed by Methicillin-resistant Staphylococcus aureus(MRSA),accounting for 33.53%;The least detected was Carbapenem-resistant Escherichia coli(CRECO),accounting for 0.70%.In terms of detection rate based on the number of strains for MDRO detected relative to the total number of strains the pathogen detected in the same period,the highest detection rate was Carbapenem-resistant Acinetobacter baumanii(CRAB),with a detection rate of 60.41%;followed by MRSA,with a detection rate of 51.50%.The detection rate of Multidrug-resistant Klebsiella pneumoniae was 49.83%,among which the detection rate of Carbapenem-resistant Klebsiella pneumonia(CRKP)was 22.97%.The detection rate of Multidrug-resistant Escherichia coli was 44.14%,and the detection rate of CRECO was 0.74%.The detection rate of Carbapenem-resistant Pseudomonas aeruginosa(CRPA)was 25.94%.Vancomycin-resistant Enterococcus(VRE)were not detected.In the past five years,the overall MDRO detection rate which the number of MDRO strains detected relative to the total number of strains detected by this pathogen in the same period,had shown a downward trend,which was 38.29% in 2017,39.73% in 2018,30.61% in 2019,28.71%in 2020,and 21.07% in 2021,respectively.(3)The results of the difference analysis of the relevant characteristics between the MDRO-HAI and MDRO-CAI showed that the differences of the two groups were statistically significant(P<0.05)for neonatal,admission to Pediatric intensive care unit(PICU),the transfer during hospitalization,underlying diseases(hematological tumors,renal or cardiovascular diseases)at admission,inpatient procedures(surgery,length of hospitalization)and invasive operations(mechanical ventilation,urinary catheter retention,invasive vascular access,indwelling gastric tube,blood transfusion,drainage,endoscopy),and the occurrence of Coronavirus Disease 2019(COVID-19)epidemic.(4)Taking MDRO infection as the dependent variable,the potential correlation factors screened by univariate analysis were included in multivariate logistic regression analysis,and the results showed that the risk of MDRO-HAI has increased after the occurrence of COVID-19 epidemic,elder,pre-Aetiology inspection of treatment therapeutic antimicrobial drugs were protective factors,and admission to PICU,surgery,mechanical ventilation and blood transfusion were independent risk factors.Conclusion In this study,the trend of overall constituent ratio and detection rate of MDRO was downward.Pediatric patients of the MDRO-HAI and MDRO-CAI had different characteristics depending on their source of infection.In view of the factors related to MDRO-HAI suggested in the study,it is of great significance to optimize MDRO monitoring,combine the standardized requirements with the actual situation of the hospital,and prudently and rationally use antibiotics to reduce MDRO infections.