Wedi'i Gadw mewn:
| Prif Awduron: | , , , , |
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| Fformat: | Recurso digital |
| Iaith: | Saesneg |
| Cyhoeddwyd: |
Zenodo
2025
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| Pynciau: | |
| Mynediad Ar-lein: | https://doi.org/10.5281/zenodo.17405564 |
| Tagiau: |
Ychwanegu Tag
Dim Tagiau, Byddwch y cyntaf i dagio'r cofnod hwn!
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Tabl Cynhwysion:
- <p>Introduction: Antibiotic resistance remains one of the major challenges in modern healthcare, particularly in hospital settings where infections with multidrug-resistant (MDR) pathogens are becoming increasingly prevalent. These infections pose significant therapeutic difficulties, especially in pediatric patients with comorbidities, due to limited antibiotic options, prolonged hospital stays, and increased clinical risks. Case description: A 10-year-old girl diagnosed with spinal muscular atrophy and neuromuscular scoliosis was admitted for corrective spinal surgery. The procedure was uneventful; however, on postoperative day 10, she developed fever, wound dehiscence, and purulent discharge. Empiric treatment with cefazolin, amikacin, and fluconazole was initiated. Microbiological cultures later identified Enterococcus faecium, Escherichia coli, and Candida spp., leading to a therapeutic switch to tigecycline and clindamycin. Two weeks later, her condition worsened with pneumonia, and cultures revealed Pseudomonas aeruginosa, Enterobacter hormaechei, and Enterococcus faecalis. Antibiotic therapy was adjusted. During hospitalization, Klebsiella pneumoniae was isolated from the wound, resistant to most antibiotics except colistin and intermediately susceptible to imipenem-cilastatin. Anaerobic bacteria (Bacteroides fragilis, Streptococcus parasanguinis) sensitive to clindamycin were also detected. She experienced two episodes of urinary tract infection: the first caused by Klebsiella pneumoniae, treated with imipenem-cilastatin, and the second involving Klebsiella aerogenes, Pseudomonas aeruginosa, Escherichia coli, and Citrobacter koseri, all susceptible to ciprofloxacin. The wound required repeated dressing changes under general anesthesia with application of a vacuum-assisted closure (VAC) system. After four months, the patient was discharged in stable condition. Discussion: This case highlights the complexity of treating MDR infections in pediatric patients with underlying conditions. The identification of multiple resistant pathogens throughout a prolonged hospital course emphasizes the essential role of early microbiological diagnostics and individualized antimicrobial therapy. Pediatric surgical patients are particularly vulnerable, and this case illustrates the importance of a tailored, multidisciplinary approach in managing such infections effectively.</p>