title: [Health care associated multidrug-resistant bacteria in a pediatric hospital: five year experience].
abstract: BACKGROUND
  In recent years there has been an increase of infections caused by multidrug-resistant bacteria. Paediatric data are scarce, particularly at national level.
  
  
  OBJECTIVE
  To analyse trends of health-care associated multidrug-resistant bacteria infections in a paediatric hospital.
  
  
  METHODS
  A retrospective incidence study was conducted in medical, surgical and intensive care wards in a level III paediatric hospital, from January 2005 to December 2009. The studied multidrug-resistant bacteria were methicillin-resistant Staphylococcus aureus (MRSA), ESBL-producing bacilli, vancomycin-resistant Enterococcus spp, multidrug-resistant Pseudomonas aeruginosa (PA-MDR) and Acinetobacter baumannii resistant to carbapenems. Demographic, clinical and laboratory data, treatment and presence of risk factors for these infections were analysed.
  
  
  RESULTS
  During the study period 106 multidrug-resistant bacteria were identified, related to 72 children, predominantly male (65.3%). The most frequently identified multidrug-resistant bacteria were MRSA (35.8%), PA-MDR (29.2%) and ESBL-producing bacilli (17.9%). Of the 106 multidrug-resistant bacteria, 45 (42.5%) were causing infection. During the study period the annual proportion of infections caused by multidrug-resistant bacteria went up from 32.0% in 2006 to 55.6% in 2009 (p = 0.376). The overall incidence rate of infection was 0.400 per 1 000 hospitalization-days, corresponding to 0.274 infections per 100 admissions, remaining stable over the five years. The most frequent infections were bloodstream (31.1%), intra-abdominal (20.0%), catheter-related (17.8%) and skin and soft tissue (11.1%). All children had risk factors and the most frequently identified were previous antibiotic therapy and underlying chronic disease (> 90%). Six children (13.3%) died during hospitalisation.
  
  
  CONCLUSIONS
  During the study period, there was an increase in the proportion of multidrug-resistant bacteria but with no statistical significance. The overall incidence rate of multidrug-resistant bacteria infection remained stable. MRSA were the most frequently identified bacteria, followed by PA-MDR and ESBL-producing bacilli. Bloodstream infections were the most frequent infections, followed by intra-abdominal and catheter-related. All children had risk factors, mainly previous antibiotic therapy and chronic disease.
authors.affiliation: Unidade de Infecciologia. Hospital Pediátrico. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.. patriciamacao@gmail.com.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Mação
authors.forename: João Casalta
authors.initials: JC
authors.lastname: Lopes
authors.forename: Henrique
authors.initials: H
authors.lastname: Oliveira
authors.forename: Guiomar
authors.initials: G
authors.lastname: Oliveira
authors.forename: Fernanda
authors.initials: F
authors.lastname: Rodrigues
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult