The prospective evaluation of risk factors and clinical influence of carbapenem resistance in children with gram-negative bacteria infection

Bal, Zümrüt Şahbudak; Bekmezci, Nur; Soylu, Mehmet; Şen, Semra; Avcu, Gülhadiye; Aydemir, Şöhret; Vardar, Fadıl

doi:10.1016/j.ajic.2017.08.013

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…The risk factors for this colonisation include recent antibiotic use, previous hospitalisation, invasive procedures, and intrafamilial transmission 14 , 18 , 19 . In children, similar risk factors have been identified 20 – 23 , together with specific risk factors such as the presence of underlying neurological conditions 22 , prematurity, low birth weight, and vertical transmission from the mother in the case of neonates. Outbreaks in paediatric and neonatal intensive care units have been reported 2 , 14 .…”

Section: Introductionmentioning

confidence: 76%

“…Exposure to broad-spectrum antibiotics, especially carbapenems, fluoroquinolones, and cephalosporin, has been associated with infection by resistant Enterobacteriaceae 20 , 23 . Our data are in line with these findings, given that antibiotic prophylaxis decreased the risk of S. aureus colonisation but increased the prevalence of MR-GNB colonisation.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions

Agud

Medrano

Méndez-Echevarría

et al. 2022

Sci Rep

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To assess drug-resistant bacterial colonisation rates and associated risk factors in children with complex chronic conditions admitted to a national reference unit in Spain. Cross-sectional study that included all children admitted to our unit from September 2018 to July 2019. Rectal swabs were obtained to determine multidrug-resistant Gram-negative bacilli (MR-GNB) colonisation, and nasal swab to determine S. aureus and methicillin-resistant S. aureus (MRSA) colonisation. Medical records were reviewed. 100 children were included, with a median of four complex chronic conditions. Sixteen percent had S. aureus colonisation, including two MRSA. S. aureus colonisation was associated with technology-dependent children, while being on antibiotic prophylaxis or having undergone antibiotic therapy in the previous month were protective factors. The prevalence of MR-GNB colonisation was 27%, which was associated with immunosuppressive therapy (aOR 31; 2.02–47]; p = 0.01), antibiotic prophylaxis (aOR 4.56; 1.4–14.86; p = 0.012), previously treated skin-infections (aOR 2.9; 1.07–8.14; p = 0.03), surgery in the previous year (aOR 1.4; 1.06–1.8; p = 0.014), and hospital admission in the previous year (aOR 1.79; [1.26–2.56]; p = 0.001). The rate of S. aureus nasal colonisation in this series was not high despite the presence of chronic conditions, and few cases corresponded to MRSA. Antibiotic prophylaxis, immunosuppressive therapies, history of infections, previous surgeries, and length of admission in the previous year were risk factors for MR-GNB colonisation.

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Section: Introductionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions

Agud

Medrano

Méndez-Echevarría

et al. 2022

Sci Rep

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“…Regarding previous antimicrobial exposure, in a recent comparative study performed in children, only carbapenem exposure was significantly associated with CRO infections in the multivariate analysis (41). Other studies in the pediatric population have also observed that prior use of carbapenems was a risk factor for CRO infection (25,31,33,(43)(44)(45).…”

Section: Risk Factors For Infection or Colonizationmentioning

confidence: 89%

“…In most cases, patients suffer from underlying comorbid conditions or were admitted to a PICU or NICU (16,37,40). Specific risk factors for colonization or infection with CRO in children include previous antibiotic exposure (mainly to broad-spectrum antibiotics and for an extended duration), the use of medical devices (mostly mechanical ventilation), an ICU stay, prior surgery, and prolonged hospitalization (18,25,31,33,(41)(42)(43)(44)(45) (Table 3).…”

Section: Risk Factors For Infection or Colonizationmentioning

confidence: 99%

Carbapenem-Resistant Gram-Negative Bacterial Infections in Children

Aguilera‐Alonso

Escosa-García

Saavedra-Lozano

et al. 2020

Antimicrob Agents Chemother

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Carbapenem-resistant organisms (CRO) are a major global public health threat. Enterobacterales hydrolyze almost all β-lactams through carbapenemase production. Infections caused by CRO are challenging to treat due to the limited number of antimicrobial options. This leads to significant morbidity and mortality. Over the last few years, several new antibiotics effective against CRO have been approved. Some of them (e.g., plazomicin or imipenem-cilastatin-relebactam) are currently approved for use only by adults; others (e.g., ceftazidime-avibactam) have recently been approved for use by children. Recommendations for antibiotic therapy of CRO infections in pediatric patients are based on evidence mainly from adult studies. The availability of pediatric pharmacokinetic and safety data is the cornerstone to broaden the use of proposed agents in adults to the pediatric population. This article provides a comprehensive review of the current knowledge regarding infections caused by CRO with a focus on children, which includes epidemiology, risk factors, outcomes, and antimicrobial therapy management, with particular attention being given to new antibiotics.

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“…A survey conducted in 226 hospitals in 41 Asian countries indicated that meropenem was widely prescribed to neonates [ 15 ]. Studies have shown that prior exposure to carbapenems is an independent risk factor for acquiring carbapenem-resistant, gram-negative bacterial infections [ 12 , 14 ]. A recent study revealed that the prevalence of carbapenem-resistant Enterobacteriaceae strains in children has been increasing annually in China [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

Gao

Guo

et al. 2020

BMC Infect Dis

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Background Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. Methods Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children’s Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. Results A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. Conclusions Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.

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The prospective evaluation of risk factors and clinical influence of carbapenem resistance in children with gram-negative bacteria infection

Cited by 6 publications

References 21 publications

Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions

Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions

Carbapenem-Resistant Gram-Negative Bacterial Infections in Children

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

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