Abstract
Background. Antibiotic resistance remains one of the key global healthcare challenges, significantly limiting the effectiveness of antibacterial therapy, especially in immunocompromised patients. In pediatric transplantation, the development of multidrug-resistant microflora is associated with an increased risk of severe infectious complications and unfavorable outcomes. Materials and Methods. This retrospective study included 50 children who underwent prirary liver transplantation in Kazakhstan between 2014 and 2024. Clinical and laboratory data and the results of bacteriological studies were analyzed. The Mann-Whitney U test, chisquare (x test, logistic regression, and ROC analysis were used (SPSS, Rl Results. n the preoperative period, antibacterial therapy was administered to 100% ofp ents. Gram-negative microorganisms predominated in the microbial flora, mainly Klebsiella spp. (16% before surgery and 20% after surgeryl. Among gram-positive pathogens, Staphylococcus is (30%) and Staphylococcus aureus (18%) were identified most frequently. Most strains demonstrated multidrug resistance to 6-lactams, fluoroquinolones, and aminoglycosides. Klebsiella-associated sepsis with a fatal outcome developed in 10 (20%) patients; pan-resistant strains were isolated in all cases. Five-year graft survival was 75%. Conclusion. A high prevalence of multidrug-resistant microflora with a predominance of {gram-negative pathogens was observed in children after liver transplantation, Previous and empirical antibacterial therapy likely contributes to the development of antimicrobial resistance. Enhanced microbiological monitoring and the implementation of antimicrobial ste wardship programs are necessary to reduce the incidence of infectious complications and improve clinical outcomes.