| Summary: | The study’s aim was to conduct a retrospective and prospective survey to determine the sensitivity patterns and prevalence of bacterial isolates obtained from cultures in patien.s with documented infections in the Paediatric Intensive Care Unit (PiCU). Also, a pharmacokinetic analysis of amikacin was done in order to determine an appropriate dosing schedule.
The most prevalent micro-organisms isolated from the retrospective survey (1995 and 1996) in the PICU was Staphylococcus epidermidis. Escherichia coli was the second most prevalent micro-organism in 1905 (also being most prevalent gram negative micro-organism for the 2 years), with Staphylococcus aureus occupying that position in 1996. The micro-organisms that demonstrated the greatest resistance in 1995 and 1996 were Enterococcus faecium and Staphylococcus epidermidis, respectively for the gram positives;and Klebsiella pneumoniae and Enterobacter sp., respectively for the gram
negatives.
From the prospective survey, a total of 124 isolates were cultured (from 57 patients) of which 70.2% were considered nosocomial infections. Clinically significant nosocomial infections were the most prevalent infection group at 41.1%. Micro-organisms classified as clinically significant nosocomial infections were fairly resistant to commonly used antibiotics tested against them, except amikacin, imipenem and vancomycin.
The pharmacokinetic phase of the study found that the twice daily dosing regimen offered subtherapeutic peak serum concentrations, and high trough serum concentrations (which could predispose a patient to nephrotoxicity).The once daily dosing regimen resulted in peak concentrations that averaged 31.2 ug/ml and trough concentrations less than 5 ug/ml.
In conclusion, due to the evolving patterns in the development of resistance of micro-organisms to antibiotics it is important to implement a routine infection control surveillance in the PICU. in addition, the most appropriate means of reporting antibiotics sensitivities from the microbiology lab needs to be developed. This information should be evaluated on a regular basis in order to determine the most appropriate interventions and these interventions need to be monitored, In order to minimise the development of resistance the
antibiotics need to be dosed appropriately and where necessary serum concentrations need to be obtained.
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