Antibiotic Resistance in the Pediatric Intensive Care Unit: Literature Review
Abstract
Antibiotics have been overused, the unwise use of antibiotics has become a special concern and has led to resistance. Almost 50% of antibiotic therapy is initiated inappropriately and without correct identification of the etiological agent. The high number of inappropriate antibiotic prescriptions contributes to the occurrence of antibiotic resistance and increased risk of death. MDR pathogens result in a 40% increase in mortality in hospital-acquired infections. The purpose of this study was to discuss the pattern of the resistance of antibiotic therapy in pediatric patients admitted to the PICU. Method: The search strategy was conducted through three databases (Google Scholar, Pubmed, Science Direct) which published during 2015-2025, using MeSH words “Antibiotic Resistance” AND “Pediatric intensive care unit”. There were thousand studies found, then by using the PRISMA flowchart, which total ten studies were included. PICU has a higher ratio of pathogen composition and bacterial resistance. Many factors can lead to antibiotic resistance, it might be caused by unnecessary or suboptimal prescribed antibiotic therapy from community before, previous health care and the hospital itself. The high number of inappropriate antibiotic prescriptions contributes to the occurrence of antibiotic resistance. Antibiotic resistance can lead to longer hospital stays and increased risk of mortality.
References
Abbas, Q., Ul Haq, A., Kumar, R., Ali, S. A., Hussain, K., & Shakoor, S. (2016). Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country. Indian Journal of Critical Care Medicine, 20(5), 291–294. https://doi.org/10.4103/0972-5229.182197
Aminov, R. I. (2010). A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future. Frontiers in Microbiology, 1. https://doi.org/10.3389/fmicb.2010.00134
Bazaid, A. S., Aldarhami, A., Bokhary, N. A., Bazaid, M. B., Qusty, M. F., AlGhamdi, T. H., & Almarashi, A. A. (2023). Prevalence and risk factors associated with drug resistant bacteria in neonatal and pediatric intensive care units: A retrospective study in Saudi Arabia. Medicine, 102(42), e35638. https://doi.org/10.1097/MD.0000000000035638
Cetin, B. S., Şahin, A., Kürkçü, C. A., Küçük, F., Sağıroğlu, P., & Akyıldız, B. N. (2022). Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit. The Journal of Pediatric Academy, 3(2), 78–84. https://doi.org/10.51271/jpea-2022-189
Chiotos, K., Blumenthal, J., Boguniewicz, J., Palazzi, D. L., Stalets, E. L., Rubens, J. H., Tamma, P. D., Cabler, S. S., Newland, J., Crandall, H., Berkman, E., Kavanagh, R. P., Stinson, H. R., & Gerber, J. S. (2023). Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10-Center Point Prevalence Study. Clinical Infectious Diseases, 76(3), e1021–e1030. https://doi.org/10.1093/cid/ciac698
Chiotos, K., Gerber, J. S., & Himebauch, A. S. (2017). How Can We Optimize Antibiotic Use in the PICU? Pediatric Critical Care Medicine, 18(9), 903–904. https://doi.org/10.1097/PCC.0000000000001261
Dar, A., Abram, T. B., & Megged, O. (2024). Impact of inadequate empirical antibiotic treatment on outcome of non-critically ill children with bacterial infections. BMC Pediatrics, 24(1), 324. https://doi.org/10.1186/s12887-024-04793-0
Durand, G. A., Raoult, D., & Dubourg, G. (2019). Antibiotic discovery: history, methods and perspectives. International Journal of Antimicrobial Agents, 53(4), 371–382. https://doi.org/10.1016/j.ijantimicag.2018.11.010
El-Nawawy, A., Mohsen, A. A., Abdel-Malik, M., & Taman, S. O. (2017). Performance of the pediatric logistic organ dysfunction (PELOD) and (PELOD-2) scores in a pediatric intensive care unit of a developing country. European Journal of Pediatrics, 176(7), 849–855. https://doi.org/10.1007/s00431-017-2916-x
Ergül, A. B., Işık, H., Ay Altıntop, Y., & Altuner Torun, Y. (2017). A retrospective evaluation of blood cultures in a pediatric intensive care unit: A three year evaluation. Turk Pediatri Arsivi, 52(3), 154–161. https://doi.org/10.5152/TurkPediatriArs.2017.5451
Fan, C., Yang, M., Mao, Y., Fang, B., He, Y., Li, R., & Qian, S. (2024). Effect of Antimicrobial Stewardship 2018 on severe pneumonia with bacterial infection in paediatric intensive care units. Journal of Global Antimicrobial Resistance, 36, 444–452. https://doi.org/10.1016/j.jgar.2023.10.017
Habboush, Y., & Guzman, N. (2024). Antibiotic Resistance.
Iskandar, K., Murugaiyan, J., Hammoudi Halat, D., Hage, S. El, Chibabhai, V., Adukkadukkam, S., Roques, C., Molinier, L., Salameh, P., & Van Dongen, M. (2022). Antibiotic Discovery and Resistance: The Chase and the Race. Antibiotics, 11(2), 182. https://doi.org/10.3390/antibiotics11020182
Kartasasmita, C. B., Rezeki Hadinegoro, S., Kurniati, N., Triasih, R., Halim, C., & Gamil, A. (2020). Epidemiology, Nasopharyngeal Carriage, Serotype Prevalence, and Antibiotic Resistance of Streptococcus pneumoniae in Indonesia. Infectious Diseases and Therapy, 9(4), 723–736. https://doi.org/10.1007/s40121-020-00330-5
Kyo, M., Ohshimo, S., Kosaka, T., Fujita, N., & Shime, N. (2019). Impact of inappropriate empiric antimicrobial therapy on mortality in pediatric patients with bloodstream infection: a retrospective observational study. Journal of Chemotherapy, 31(7–8), 388–393. https://doi.org/10.1080/1120009X.2019.1623362
M, H. (2018). Program pengendalian resistensi antimikroba dan pemakaian antibiotik pada anak. Dalam : Hadinegoro S, Moedjito I, Hapsari M, Alam A, penyunting. Buku ajar infeksi & penyakit tropis. (4th ed.). Ikatan Dokter Anak Indonesia.
Murni, I. K., Duke, T., Daley, A. J., Kinney, S., & Soenarto, Y. (2016). Antibiotic Resistance And Mortality In Children With Nosocomial Bloodstream Infection In A Teaching Hospital In Indonesia. Southeast Asian J Trop Med Public Health, 47(5).
Nasso, C., Scarfone, A., Pirrotta, I., Rottura, M., Giorgi, D. A., Pallio, G., Irrera, N., Squadrito, V., Squadrito, F., Irrera, P., Arcoraci, V., & Altavilla, D. (2022). Appropriateness of Antibiotic Prescribing in Hospitalized Children: A Focus on the Real-World Scenario of the Different Paediatric Subspecialties. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.890398
Pudjiadi, A. H., Latief, A., & Budiwardhana, N. (2011). Buku Ajar Pediatri Gawat Darurat. Badan Penerbit Ikatan Dokter Anak Indonesia.
Rezk, A. R., Bawady, S. A., & Omar, N. N. (2021). Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care. Egyptian Pediatric Association Gazette, 69(1), 25. https://doi.org/10.1186/s43054-021-00071-1
Romandini, A., Pani, A., Schenardi, P. A., Pattarino, G. A. C., De Giacomo, C., & Scaglione, F. (2021). Antibiotic Resistance in Pediatric Infections: Global Emerging Threats, Predicting the Near Future. Antibiotics, 10(4), 393. https://doi.org/10.3390/antibiotics10040393
Sakhr, A. M., Ghazaly, M. M. H., & Mohamad, I. L. (2018). Audit of Antibiotic Uses in Pediatric Intensive Care Unit of Assiut University Hospital. Med. J. Cairo Univ., 86(7), 3937–3941.
Sundariningrum, R. W., Setyanto, D. B., & Natadidjaja, R. I. (2020). Evaluasi Kualitatif Antibiotik Metode Gyssens dengan Konsep Regulasi Antimikroba Sistem Prospektif RASPRO pada Pneumonia di Ruang Rawat Intensif Anak. Sari Pediatri, 22(2), 109–114.
Uddin, T. M., Chakraborty, A. J., Khusro, A., Zidan, B. R. M., Mitra, S., Emran, T. Bin, Dhama, K., Ripon, Md. K. H., Gajdács, M., Sahibzada, M. U. K., Hossain, Md. J., & Koirala, N. (2021). Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects. Journal of Infection and Public Health, 14(12), 1750–1766. https://doi.org/10.1016/j.jiph.2021.10.020
Ventola, C. L. (2015). The Antibiotic Resistance Crisis Part 1: Causes and Threats. P&T, 40(4), 277–283.
von Beck, L. M., Rapszky, G. A., Kiss, V. E., Sandor, S., Gaal-Marschal, S., Berenyi, T., Varga, C., & Fenyves, B. G. (2025). Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study. BMC Emergency Medicine, 25(1), 18. https://doi.org/10.1186/s12873-025-01177-0
Wang, Z., & Xia, Z. (2020). What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): A case-control study. Italian Journal of Pediatrics, 46(1). https://doi.org/10.1186/s13052-019-0769-9
Wayan Putra, I., Setyaningtyas, A., Puspitasari, D., Dwi Wahyu, A., Dharmawati, I., & Latief Azis, A. (2019). Microbial Pattern And Antibiotic Susceptibility In Pediatric Intensive Care Unit Dr. Soetomo Hospital, Surabaya. Indonesian Journal of Tropical and Infectious Disease, 7(5).
Willems, J., Hermans, E., Schelstraete, P., Depuydt, P., & De Cock, P. (2021). Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review. Pediatric Drugs, 23(1), 39–53. https://doi.org/10.1007/s40272-020-00426-y
Yuniar, I., Karyanti, M. R., Tambunan, T., & Rizkyani, N. A. (2013). Evaluasi Penggunaan Antibiotik dengan Kartu Monitoring Antibiotik Gyssens. Sari Pediatri, 14(6).
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