Çocuk Hastalarda Kan Kültürü ile Tespit Edilen Patojenlerde Antibiyotik Direnci ve Mikroorganizma Dağılımı

Antibiotic Resistance Patterns and Distribution of Microorganisms Identified in Blood Cultures from Pediatric Patients

Abstract

Aim and Background: The incidence of bacteremia caused by multidrug-resistant bacteria is increasing worldwide. Identifying the causative agents of these infections and initiating appropriate antibiotic therapy early are crucial. This study aims to contribute to the determination of the etiology of bacteremia and sepsis and to guide the development of effective treatment strategies based on the collected data.

Materials and Methods: Patients with positive blood culture results between 2010 and 2021 in a university hospital were analyzed in terms of pathogen diversity and antibiotic resistance. Blood culture data, including patient information, bacterial isolates, and antibiograms, were electronically retrieved from hospital records. Patients' age, sex, and CRP levels were recorded. Categorical variables were presented as counts and percentages.

Results: Of the 4711 blood cultures obtained from the Pediatric Clinic, 736 (15.6%) showed bacterial growth. The mean age of patients with positive cultures was 11.11 ± 5.24 years, and 50.82% were female. The mean CRP level in the study group was 48.48 ± 59.76, with higher levels observed in Gram-negative infections (p < 0.001). The most frequently isolated organism was Staphylococcus epidermidis (41.04%), followed by Staphylococcus aureus (4.48%). Gram-positive bacteria accounted for 87.91% of isolates, fungi for 1.09%, and Gram-negative bacteria (GNB) for 11.00%. Among GNBs, Enterobacter accounted for 3.67%, Salmonella for 2.17%, and Klebsiella for 0.54%. Methicillin resistance was detected in 18.8% of S. aureus isolates and in 85.0% of S. epidermidis isolates. No third-generation cephalosporin (TGC) resistance was found in Salmonella isolates. For Klebsiella, TGC resistance was 100%, while carbapenem resistance was 7.1%. In Acinetobacter species, amikacin resistance was 46.7%, meropenem resistance was 37.5%, and TGC resistance was 16.7%.

Conclusion: Gram-positive bacteremia was common, with a high rate of methicillin resistance. While third-generation cephalosporin could be excluded as treatment options for Klebsiella, sensitivity to these antibiotics persists in Salmonella infections. Empirical antibiotic selection for bacteremia may vary depending on clinical settings.