Multicenter Study of the Risk Factors for Colonization or Infection with Carbapenem-Resistant Enterobacteriaceae in Children

Abstract

Carbapenem-resistant (CRE) are increasingly identified in children in the United States, but data on the epidemiology of CRE in this population are limited. The objectives of this study were to characterize the risk factors for colonization or infection with CRE and describe the microbiologic characteristics of pediatric CRE isolates. We performed a multicenter matched case-control study from January 2011 to October 2015 at three tertiary care pediatric centers. Case patients were hospitalized children with CRE isolated from clinical cultures and were matched in a 2:1 ratio to control patients with carbapenem-susceptible (CSE). Risk factors for colonization or infection with CRE were then evaluated using a multivariable conditional logistic regression. Additionally, we comprehensively reported the antimicrobial susceptibility pattern for CRE isolates. Sixty-three case patients were identified and matched to 126 control patients. On multivariable analysis, antipseudomonal antibiotic exposure within the previous 3 months (odds ratio [OR], 5.20; 95% confidence interval [CI], 1.71 to 15.9; = 0.004), prior surgery (OR, 6.30; 95% CI, 1.83 to 21.6; = 0.003), and mechanical ventilation (OR, 12.4; 95% CI, 1.26 to 122; = 0.031) were identified as risk factors for colonization or infection with CRE. Pediatric CRE isolates demonstrated relatively low rates of resistance to amikacin (5%) and ciprofloxacin (25%). Our findings support an important role for antibiotic stewardship interventions limiting the unnecessary use of antipseudomonal antibiotics as a strategy to prevent widespread emergence of CRE in children. Future studies should further characterize molecular determinants of antibiotic resistance among pediatric CRE isolates.

Documento de posicionamiento de la Asociación Española de Pediatría-Sociedad Española de Infectología Pediátrica sobre el tratamiento de las infecciones por bacterias multirresistentes

“…Las infecciones por estos microorganismos presentan mayor mortalidad 19 y comparten factores de riesgo similares a los observados en los BGN productores de BLEE. 20…”

A New Suite of Allelic-Exchange Vectors for the Scarless Modification of Proteobacterial Genomes

“…Original reports of cephalosporin failure in E. cloacae (34) engendered the practice of using ultra-broad-spectrum antibiotics (such as cefepime or carbapenems, which are resistant to AmpC hydrolysis) in the treatment of serious infections by pathogens with the potential for AmpC overexpression. However, this approach has untoward consequences, including increasing infections with carbapenem-resistant Enterobacteriaceae (35).…”

The characteristics of antimicrobial resistance and treatment of carbapenem-resistant Enterobacteriaceae infections in children from 2013 to 2018 in a chinese tertiary hospital

“…Few studies have used rigorous methods to guide children's treatment options, and the data must be inferred from adult literature. After children are infected with CRE, the choice of treatment will be more limited due to restrictions on antibiotics for children [9][10][11][12]. Here we retrieved pediatric CRE infection cases from 2013 to 2018 in a tertiary general hospital.…”