The relationship between bacterial types and antibiotic resistance with the clinical outcomes of sepsis patients in Pediatric Intensive Care Unit at Sanglah Hospital Denpasar, Bali-Indonesia

Background: Sepsis in children could significantly increase the morbidity and mortality rates particularly in the Pediatric Intensive Care Unit (PICU). Moreover, the prevalence of antibiotic resistance is continuously increasing around the world mainly caused by uncontrolled used of antibiotic. Henceforth, this study aimed to determine the relationship between bacterial type and the resistance with clinical outcome of sepsis patients in PICU.Methods: An observational analytic retrospective cohort study using medical record data from January 2015-April 2017 was conducted. All subjects were sepsis patients with positive blood cultures treated at PICU Sanglah Hospital. Factors related to mortality and relative risk (RR) were analyzed using Chi-Square Test with a significance value of p <0.05 with 95% confidence interval (CI).Results: 75 subjects met the inclusion criteria, but only 63 subjects with complete data were enrolled. The gram-negative and MDR bacteria types were detected in 31 (49%) subjects and 33 (52.4%) subjects respectively. The number of deaths was 29 (46%). The most common types of gram-negative bacteria were Pseudomonas aeruginosa (16%) followed by gram-positive Staphylococcus hominis (25%). The most common multi-drug resistant (MDR) bacteria were Staphylococcus hominis. The presence of MDR bacteria significantly increase the mortality (p = 0.015, RR 2.02, 95% CI: 1.096-3.725), whereas gram-negative had no significant mortality impact (p = 0.891: RR 0.96; 95% CI: 0.564- 1.645). Compared to non-MDR bacteria, most MDR related mortality occurred during the first 10 days.Conclusion: MDR bacteria significantly increased the mortality rates in pediatric patient treated in PICU compared to non-MDR ones.