Surveillance of Multidrug-Resistant Organisms and Trends in Antimicrobial Susceptibility in Chronically Hospitalized Pediatric Patients

Background: Patients in long-term care facilities experience greater risk of infections, along with use of long-lasting invasive devices and colonization of multidrug resistant organisms. This study aims to analyze surveillance and clinical specimen culture results and trends in antimicrobial susceptibility among long-term hospitalized pediatric patients. Materials and Methods: Data were collected retrospectively from January 2015 to December 2024 from a long-term care facility dedicated to children with chronic underlying diseases. All hospitalized patients that underwent clinical specimen collection as part of infection surveillance or clinical evaluation were included. Results: From 2015 to 2024, 759 admissions (357 new, 402 readmissions) were recorded, and 4,623 clinical specimens were collected. A total of 216 bacterial isolates were identified (4.7% positivity rate) from 130 medically complex pediatric patients, 98.8% of whom were bedridden. Between 2019 and 2024, 14 bloodstream infection (BSI) episodes occurred in 12 patients, with 85.7% suspected to be catheter-related. The BSI isolation rate was 0.21 per 1,000 resident-days, and the BSI-attributable mortality rate was 14.3%. From 2016 to 2024, methicillin-resistant Staphylococcus aureus (MRSA) nasal/sputum positivity increased from 3.5% to 5.9%, and the MRSA isolation rate rose significantly from 0.128 to 0.367 per 1,000 resident-days (P=0.009). Rectal carbapenem-resistant Enterobacteriaceae (CRE) positivity increased significantly from 0% to 3.4% (P=0.004), with isolation rates rising from 0 to 0.149 per 1,000 resident-days (P=0.012). Conclusion: This 10-year study highlights a low incidence of BSIs in a medically complex pediatric long-term care population, likely due to proactive infection control measures. However, rising trends in MRSA and CRE colonization underscore the need for continued surveillance and the development of pediatric-specific infection prevention strategies.