A systematic review of Gram-negative bacterial prevalence and antibiotic resistance in pediatric sepsis: Insights from pediatric intensive care units

Abstract

Sepsis is a major cause of mortality among critically ill children, particularly affecting neonates and children under five. Gram-negative bacteria (GNB) have emerged as significant pathogens in pediatric intensive care units (PICUs), contributing to high rates of antimicrobial resistance and complicating treatment outcomes. This systematic review aims to determine the prevalence and antibiotic resistance patterns of Gram-negative bacterial infections in pediatric sepsis cases within PICUs and to identify associated risk factors. An extensive search was conducted in PubMed and MEDLINE for studies published between 2019 and 2024, focusing on studies involving pediatric patients in PICUs with documented GNB infections. After a rigorous selection process, 11 articles were included in the review. The prevalence of GNB in PICUs varied widely across the studies, ranging from 5% to 65.7%, with a mean prevalence of 38.5%. Common pathogens included Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. The rate of multidrug-resistant Gram-negative pathogens ranged from 18.2% to 63.7%, with a mean of 47%. Key risk factors identified included previous PICU stays, invasive procedures, and prior antibiotic use. The findings underscore the significant burden of Gram-negative bacterial infections and the high levels of antibiotic resistance in PICUs. There is an urgent need for enhanced diagnostic practices, targeted infection control measures, and robust antimicrobial stewardship programs to manage and mitigate the impact of these infections. Future research should focus on validating these findings and developing effective interventions to improve patient outcomes in pediatric settings.

Keywords

• antimicrobial resistance
• gram-negative bacteria
• multidrug-resistant organisms
• pediatric intensive care units
• pediatric sepsis