الفهرس 
Management and Outcome of Multidrug Resistant Klebsiella and other Enterobacteriaceae causing Ventilator- Associated Pneumonia in Critically ill Children
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Abstract
to optimize the best antibiotic combinations against MDR klebsiella and other Enterobacteriaceae organisms causing VAP by testing susceptibility of well-known antibiotics combinations using AZDAST method in comparison to single antibiotic susceptibility testing by DD and MIC, and comparing clinical and radiological outcome between the two studied groups.
Design, setting and participants: this is prospective observational study which was conducted on 60 patients who were admitted to Pediatric Intensive Care Unit (PICU) who were diagnosed as VAP.
Intervention: ETA cultures and antibiotic sensitivity testing by DD, MIC and AZDAST were performed for each patient. Treatment regimens has been changed according to laboratory results.
Results: presence of cardiac problems whether congenital or acquired, neurological disorders and endocrine problems increase risk of non-improvement of VAP among the studied children (p-value <0.05).Blood stream infection with klebseilla MDR increase the risk of non-improvement of VAP caused by the same organism (p-value =0.001). PDR organisms increase risk of non-improvement of VAP than both XDR and MDR, also less improvement of XDR than MDR with p-value =0.001. Ceftazidime/avibactam + gentamycin had the highest percentage of synergism and potentiation with least percentage of antagonism in AZDAST results.
Conclusions: AZDAST had a better outcome than MIC in treating MDR klebseilla in our units . Ceftazidime/avibactam then Tigacycline had the best response in treating VAP in our units.