Multidrug-resistant organism carriage in children admitted to a pediatric intensive care unit of a Greek tertiary hospital: prevalence and risk factors

BACKGROUND: Antimicrobial resistance is a global public health threat. Colonization with multidrug-resistant organisms (MDROs) often precedes infection and promotes transmission. However, data in pediatric populations remain limited. This study aimed to determine the prevalence of MDRO carriage among children admitted from the community to a Greek Pediatric Intensive Care Unit (PICU) and to explore associated risk factors. METHODS: A cross-sectional study of children aged 0-16 years admitted to the PICU was conducted from January 1st to June 30th, 2024, excluding those hospitalized > 48 h or residing in care facilities. MDROs were identified from nasal, rectal, or bronchial secretion cultures collected within 48 h of admission. Epidemiological and clinical data were retrieved from medical records, and statistical analysis was performed to explore potential associations. RESULTS: Of 86 included children (median age 4.5 years, IQR 1-11; 53.5% male), 80 were screened within 48 h. MDRO colonization was identified in 18/80 patients (22.5%). ESBL-producing Escherichia coli (40.0%) and MRSA (20.0%) predominated. In exploratory multivariable analysis, lower absolute body weight (kg) was associated with MDRO carriage, with each 1 kg increase corresponding to approximately 18% lower colonization risk (OR = 0.818, 95% CI 0.680-0.984, P = 0.033), whereas no significant association was observed for weight-for-age. CONCLUSIONS: High rates of MDRO carriage in children admitted from the community to a PICU highlight an important public health concern and the need for enhanced preventive measures.