Characteristics of dominant conditionally pathogenic microbiota among critically ill children during the operation of the anesthesiology and intensive care unit in shelter conditions during the war in Ukraine

Abstract

The relevance of this study lies in examining the dominant opportunistic microbiota among critically ill children in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital during wartime in Ukraine. This is crucial for understanding the impact of antimicrobial resistance on the treatment of infections. The aim of the study was to identify the spectrum of dominant opportunistic microorganisms in patients admitted to the Pediatric Intensive Care Unit, which operated from a shelter facility during 2023, and to assess the antibiotic susceptibility of leading pathogens. Microbiological analysis was conducted on biological material obtained from 25 critically ill children diagnosed with various conditions, including acute bronchitis, pneumonia, acute hematogenous osteomyelitis, closed traumatic brain injury, mechanical asphyxia, severe carbon monoxide poisoning, polytrauma, and epilepsy. Samples were collected on the day of admission to the Pediatric Intensive Care Unit and subsequently every three days until discharge or transfer. Key findings revealed that the dominant pathogens included Staphylococcus aureus (25%), Candida albicans (24.1%), Enterobacter aerogenes (17.6%), Pseudomonas aeruginosa (16.7%), and Klebsiella pneumoniae (6.9%). These microorganisms exhibited high levels of antibiotic resistance, complicating infection treatment. Clinical isolates of Enterobacter aerogenes and Enterobacter cloacae showed resistance to meropenem (97.4%), while Klebsiella oxytoca and K. pneumoniae were resistant to commonly used antibiotics. Analysis of S. aureus susceptibility indicated 100% sensitivity to linezolid, but high resistance to amoxicillin and trimethoprim (74%). The study highlights the urgent need for rational antibiotic use, careful selection and combination of existing drugs for improved therapeutic outcomes, and enhanced strategies for infection control and prevention to ensure effective treatment of infections in critically ill pediatric patients.