title: Multi-drug resistant gram negative infections and use of intravenous polymyxin B in critically ill children of developing country: retrospective cohort study.
abstract: BACKGROUND
  Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care. To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. We also report safety of Polymyxin B use in these patients.
  
  
  METHODS
  Files of patients admitted in PICU of Aga Khan University Hospital, from January 2010 to December 2011, one month to 15 years of age were reviewed. Demographic and clinical features of patients with MDR gram negative infections, antibiotic susceptibility pattern of isolates, discharge disposition and adverse effects of Polymyxin B were recorded.
  
  
  RESULTS
  A total of 44.8/1000(36/803) admitted patients developed MDR gram negative infections, of which 47.2%(17/36) were male, with mean age of 3.4 yrs(+/-4.16). Acinetobacter Species (25.5%) was the most frequently isolated MDR organisms followed by Klebsiella Pneumoniae (17%). Sensitivity of isolates was 100% to Polymyxin B, followed by Imipenem (50%), and piperacillin/tazobactem (45%). The crude mortality rate of patients with MDR gram negative infections was 44.4% (16/36). Fourteen of 36 patients received Polymyxin B and 57.1%; (8/14) of them were cured. Nephrotoxicity was observed in 21.4% (3/14) cases, none of the patients showed signs of neuropathy.
  
  
  CONCLUSIONS
  Our study highlights high rates of Carbapenem resistant gram negative isolates, leading to increasing use of Polymyxin B as the only drug to combat against these critically ill children. Therefore, we emphasizeon Stewardship of Antibiotics and continuous surveillance system as strategies in overall management of these critically ill children.
authors.affiliation: Department of Pediatrics and child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan. drnrsvd@hotmail.com.
authors.forename: Naveed-ur-Rehman
authors.initials: NU
authors.lastname: Siddiqui
authors.affiliation: Department of Pediatrics and child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan. farah.qamar@aku.edu.
authors.forename: Farah Naz
authors.initials: FN
authors.lastname: Qamar
authors.affiliation: Department of Pediatrics and child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan. humaira.jurair@aku.edu.
authors.forename: Humaira
authors.initials: H
authors.lastname: Jurair
authors.affiliation: Department of Pediatrics and child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan. anwar.haq@aku.edu.
authors.forename: Anwarul
authors.initials: A
authors.lastname: Haque
mesh_terms: D000150:Acinetobacter / Q000187:drug effects*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003141:Communicable Diseases; D016638:Critical Illness; D003906:Developing Countries / Q000706:statistics & numerical data; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D011112:Polymyxin B / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B