# Infections in Pediatric Palliative Care Units: Clinical and Microbiological Perspectives from a Single Center

## TL;DR

This study examines infections and drug-resistant bacteria in a pediatric palliative care unit, finding that invasive devices and prolonged hospital stays increase the risk of resistant infections.

## Contribution

The study provides clinical and microbiological insights into MDR infections in a PPC unit, identifying risk factors specific to this vulnerable patient population.

## Key findings

- Lower respiratory tract infections were the most common, followed by sepsis and urinary tract infections.
- Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequently isolated pathogens.
- MDR infections were significantly associated with percutaneous endoscopic gastrostomy or mechanical ventilation use.

## Abstract

Aim: Infections and multidrug-resistant (MDR) pathogens are concerns in pediatric palliative care (PPC) units, where children with life-limiting conditions undergo invasive procedures and prolonged hospitalization. This study evaluated clinical characteristics, microbiological profiles, and factors associated with MDR infections among pediatric patients hospitalized in a PPC unit. Methods: This retrospective observational study included 66 children aged 1 month to 18 years who were admitted to the PPC unit of our hospital due to infection between June 2023 and January 2024. Demographic data, comorbidities, device use, infection sites, and microbiological results were reviewed. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2 system and interpreted according to EUCAST. Results: The median age was 48 months (IQR 19–106); 63.6% were male. Lower respiratory tract infection was most common (68.2%), followed by sepsis (13.6%) and urinary tract infection (12.1%). Pseudomonas aeruginosa (36.4%) and Klebsiella pneumoniae (27.3%) predominated. MDR organisms represented 15.2% of isolates. MDR infections were significantly associated with percutaneous endoscopic gastrostomy or mechanical ventilation use (p = 0.033). Prolonged hospitalization and multiple comorbidities tended to increase the MDR risk but did not reach statistical significance. Conclusions: Gram-negative MDR infections constitute an important problem in PPC units. Frequent exposure to invasive devices and antibiotics increases susceptibility to resistant pathogens. Reinforcing infection prevention, optimizing antimicrobial stewardship, and monitoring device-related infections are essential to reduce morbidity and improve care quality in pediatric palliative care.