Emergence of Antibiotic Resistance in Intensive Care Unit: Experience of Dhaka Shishu (Children) Hospital Pediatric Cardiac Intensive Care Unit

Mohammad Abdullah Al Mamun1, Manzoor Hussain2, Rezoana Rima3, Abdul Jabbar4, Nawshika Sharmin Echo5

Background: Antibiotics are the most common therapies administered in the intensive
care unit (ICU) setting. The rapid emergence and dissemination of antimicrobial resistant
microorganisms in ICUs worldwide constitutes to be a serious problem now a day.
Objectives: This study was aimed to investigate the initial antibiotics used before
ICU admission, pathogen distribution and antimicrobial susceptibility among the
congenital heart disease (CHD) children admitted to ICU.
Methods: This prospective study was conducted in Pediatric Cardiac Intensive Care
Unit (PCICU) of Dhaka Shishu (Children) Hospital from June 2015 to May 2016.
Patients having cardiac problems from all over the country were transferred for
medical management during the study period was enrolled. Blood, urine and tracheal
aspirate were sent when infection was suspected. Antibiotics used before PCICU
admission was noted. Data were collected and analyzed by using SPSS version 17.
Result: During the study period total 305 patients were admitted and almost all
received broad spectrum antibiotics including third generation cephalosporins (36.8%),
carbepenem (17.7%) even piperacillin (3.3%) and colistin (8.4%) before admission in
PCICU. Organisms were isolated in 10.82% cases and majority were gram negative
(Acinatobactor 42.4%, Klebsiella 21.2%, and Pseudomonas 24.2%). Multi drug resistant
(MDR) Acinatobacter was found in 90.99% cases and 9.09% was pan drug resistant.
Acinatobacters were resistant to conventional antibiotics, even resistant to piperacillin
in 85.7% and carbapenem in 78.6% cases. Klebsiella, Pseudomonas and E. Coli was
also found resistant to commonly used antibiotics. They also showed higher resistant
to piperacillin and carbapenema. Staphylococcus showed 100% resistant to ampicillin,
50% to gentamicin, ceftazidime, ceftriaxone and amikacin. Mortality was significantly
higher among MDR cases (p<0.05).
Conclusion: There is emergence of multidrug resistant organisms in PCICU with
very few options to treat which may be related to inappropriate use of antibiotics. To
combat and to reduce the mortality judicious use of antibiotic is essential.
Kew wards: Antibiotic resistant, ICU.

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