# Profile of Multidrug-Resistant Bacteria in Intensive Care Units of a Maternal and Child Hospital in Rio de Janeiro, Brazil

## TL;DR

This study analyzed multidrug-resistant bacteria in intensive care units at a hospital in Rio de Janeiro, finding high resistance rates in neonatal and pediatric patients.

## Contribution

The study provides a detailed profile of MDR bacteria in maternal and child hospital ICUs in Brazil, emphasizing resistance patterns in neonates and pediatric patients.

## Key findings

- Coagulase-negative staphylococci (CoNS) were most common in neonatal blood cultures.
- MRSA was detected in all nasal swabs, and 30–50% of Gram-negative isolates showed resistance to cephalosporins or carbapenems.
- ESBL-producing organisms were found in 40% of rectal swabs, highlighting significant resistance in pediatric ICUs.

## Abstract

Background/Objectives: Epidemiological surveillance of healthcare-associated infections (HAIs) and multidrug-resistant (MDR) bacteria is a key responsibility of hospital infection control committees (HICC). Active surveillance swabs facilitate the early detection of colonized patients; helping to prevent MDR pathogen transmission in intensive care units. This study aimed to describe antimicrobial resistance profiles of bacterial isolates from clinical samples in neonatal and pediatric intensive care units. Methods: A retrospective cross-sectional study was conducted at a maternal and child hospital in Rio de Janeiro, Brazil including patients aged 0–18 years admitted to neonatal (NICU), surgical (SICU), and pediatric (PICU) intensive care units between January and December 2023. A total of 286 positive cultures were analyzed from different sample types including blood, urine, tracheal aspirates, cerebrospinal fluid (CSF), and catheter tips as well as screening swabs (nasal and rectal) for colonization surveillance. Bacterial isolates were identified and tested for antimicrobial susceptibility following BrCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) guidelines. Results: Of the 286 cultures, 146 (51%) originated from the NICU, 70 (24%) from the SICU, and 70 (24%) from the PICU. Coagulase-negative staphylococci (CoNS) predominated in blood cultures, especially among neonates, while MRSA was found in all nasal swabs. Among the Gram-negative bacteria; Klebsiella pneumoniae and Pseudomonas aeruginosa were the most frequent isolates, with 30–50% resistant to third-generation cephalosporins or carbapenems. ESBL-producing organisms were found in 40% of rectal swabs. Conclusions: The predominance of CoNS in neonatal ICUs and high resistance rates among Gram-negative bacteria highlight the urgent need for continuous microbiological surveillance and antimicrobial stewardship in vulnerable pediatric populations.