Monitoring and Antibiotic Resistance Profile of Tracheal Aspirate Microbiota in ICU Children with Severe Craniocerebral Trauma

Abstract

Nosocomial infections and their rational antibiotic treatment represent a major challenge for the healthcare nowadays. In this context, gramnegative bacteria including Pseudomonas aeruginosa, Acinetobacter baumanii and Enterobacteriaceae spp. are etiologically important and characterized by a significant level of antibiotic resistance. To examine dynamics of the respiratory tract colonization by hospital flora, tracheal aspirates obtained at three time points from 69 children with severe craniocerebral trauma during their stay in ICU were analysed. Colonization was observed on the 4th day of the ICU stay with predomination of K.pneumoniae (45%) and A.baumanii (27-37%). P.aeruginosa was detected after the 8th day of the ICU stay with the isolation rate of 33%. Substantial proportions of P.aeruginosa (61%), A.baumanii (78%) and K.pneumoniae (25%) were resistant to carbapenems. In 65 carbapemen resistant isolates, the presence of carbapenemases was examined using PCRs. OXA-48 carbapenemase was detected in 11 out of 14 (78%) K.pneumoniae isolates. Among the A.baumanii isolates, 30/31 (97%) carried OXA-40 and 1/31 (3%) had OXA-23 carbapenemases. None of the examined A.baumanii and K.pneumoniae isolates produced metallo-betalactamases (MBL). In contrast, all 20 car-bapenem resistant P.aeruginosa isolates produced a MBL, and in 12 out of 20 (60%) of theme VIM-2 was detected. Thus, gramnegative nosocomial microflora rapidly colonizes ICU patients and has a high level of resistance to antibiotics, including carbapenems.

Keywords

• nosocomial microbiota
• intensive care unit
• antibiotic resistance
• carbapenemases
• children