Determinants of Antimicrobial Resistance of Gram-Negative Bacteria in Paediatric Patients at Victoria Chitepo Provincial Hospital, 2024.

Abstract

Antimicrobial Resistance in Gram-negative bacteria is a pressing global health issue, particularly affecting vulnerable populations such as pediatric patients. It has become an important threat to international health which is potentially undermining nearly a century of gains since antibiotics were discovered. This study investigates the determinants of Antimicrobial Resistance at Victoria Chitepo Provincial Hospital. A cross-sectional study design was employed, using retrospective clinical and laboratory data from 250 pediatric patients. A systematic random sampling method was used. The analysis involved descriptive statistics and binary logistic regression to assess the influence of potential determinants on the likelihood of antimicrobial resistance. Visual tools such as bar charts and forest plots were also utilized to enhance interpretation. Key findings revealed that Gram-negative bacteria accounted for 60% of the isolates, with the highest prevalence observed among infants aged 0–23 months. Age was found to be significantly associated with GNB infection, while gender was not. The antimicrobial resistance patterns showed widespread resistance to commonly used antibiotics such as Amoxicillin-Clavulanate and TMP-SMX, particularly among Acinetobacter baumanni and Pseudomonas aeruginosa. Even Gentamicin, the most effective antibiotic in this study, showed only moderate susceptibility rates. Logistic regression analysis identified several significant determinants of antimicrobial resistance with the most influential factor being prior antibiotic use with an Odds Ratio of 3.2 followed by history of urinary tract infections (OR=2.4), HIV-positive status(OR=1.9), and behavioral factors such as purchasing antibiotics without a prescription(OR=2.1) and early discontinuation of treatment(OR=1.8). Younger age was also found to be associated with antimicrobial resistance most probably due to the underdeveloped immune systems of babies. Socio-demographic factors including residence in high-density areas and low parental education also showed significant associations with resistance. Overall, the study provided a comprehensive and statistically supported assessment of the prevalence, resistance trends, and drivers of AMR in Gram-negative infections among young children by highlighting the interplay between biomedical vulnerabilities and modifiable behavioral factors. These results advocate for immediate action in public health policy and clinical practice, emphasizing the importance of targeted educational interventions for caregivers and stricter regulations on antibiotic prescriptions.