الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The treatment of childhood bacteremia is threatened by the steady increase in the prevelance of antimicrobial resistance (AMR). Resistance among gram negative bacilli is now the key global concern because the spread of multidrug resistant GN bacilli is increasing and there are avery limited number of antimicrobial agents in late stage development. Antimicrobial resistance has been increasing for several years and is often higher in ICUs than in other facilities. The diversity of organisms causing sepsis varies from region to another and changes over time even in the same place. There is an alarming increase in antibiotic resistance to the commonly used antibiotics. Continuous surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy. This study ws an observational descriptive cross-sectional study conducted at Mansoura University Children’s Hospital. Its main objective was to investigate the pattern of antimicrobial susceptibility and resistance, as well as the prevalence of multidrug-resistant infections, primarily among immunocompetent patients in the PICU. The study aimed to identify risk factors associated with the isolation of MDRO and examine their related outcomes. The study included a total of 80 infants and children under the age of 18 who were treated in the PICU. The data collection period spanned from October 2020 to October 2021, and all participants had at least one episode of positive culture during their treatment. The median age of the studied children was 14.5 months ranging from one month to 172 months. 38.8% of them were males and 61.2% were females. Most of them, 58.8% were from rural residence while 41.2% were from urban residence. The most prevalent cause of admission was respiratory distress in (41.2%) followed by DCL in (36.2%) of children. GN bacilli were the most frequently isolated micro-organisms, accounting for 61 isolates or 49.2% of the total. Among GN bacilli, Klebsiella pneumoniae was the most common with 32 isolates (25.8%), followed by Echerichia coli and P.aeruginosa. GP micro-organisms were present in almost half of the isolates, with 27 isolates of COPSc, 21 isolates of CONSc, and 15 isolates of GPDc. Approximately 50% of GP bacteria strains were found to be MDR. Among Staphylococcus aureus strains, 44% were identified as MRSA, while 11% of these isolates showed resistance to vancomycin VRSA. Vancomycin resistance was detected in 6 GP isolates, accounting for 9% of the total, which is a concerning finding that should be taken into consideration. GP isolates demonstrated the highest sensitivity to Vancomycin, with a rate of 65.1%. Cefoperazone exhibited the next highest sensitivity at 38.1%, followed by Linezolid at 34.9%. Conclusion: Respiratory distress was found to be the most prevalent cause of admission to PICU, followed by disturbed consciousness level. The incidence of multidrug-resistant (MDR) organisms was observed to be high. Both Gram-positive (GP) and Gram-negative (GN) organisms exhibited a high prevalence of resistance to various antimicrobial classes. The profile of bacterial resistance in our PICU primarily consisted of MDR gram-negative bacilli, such as Klebsiella pneumoniae, which is a major global concern in both developed and developing countries.