Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
Pediatr Infect Dis J. 2013 Apr;32(4):e151-4. doi: 10.1097/INF.0b013e3182804b49.
Carbapenem-resistant Gram-negative pathogens (CRPs) are emerging as major causes of nosocomial infections that increase morbidity, mortality and healthcare costs. Little is known about CRP infections in children.
All newly detected infections caused by carbapenem-resistant Klebsiella spp, Pseudomonas spp or Acinetabocater spp in hospitalized patients are prospectively reported to the Hellenic Center for Disease Control and Prevention. All children <15 years old with a CRP infection reported from November 1, 2010, through March 30, 2012, were included in this study.
Between November 2010 and March 2012, 71 CRP infections in 65 children (median age: 1 year) were reported. Underlying conditions existed in 50 (76.9%) children. Cases included pneumonia (25 [35.2%], including 20 ventilator-associated pneumonias), bacteremia (32.4%), urinary tract infection (19.7%) and surgical site infection (12.7%). Isolates were Pseudomonas spp (41.1%), Acinetobacter spp (39.7%) and Klebsiella spp (19.2%). The first positive culture occurred a median of 20 days (range: 0-313 days) after admission. Twenty-four (33.8%) infections occurred in patients with a history of hospitalization the previous 6 months; 42 (59.2%) and 36 (50.7%) infections occurred among patients who had received broad-spectrum antibiotics including carbapenems the previous 6 months, respectively. The crude mortality at 28 days after the first positive CRP culture was 21.1%.
Infections caused by CRPs among children are associated with significant morbidity and mortality.
耐碳青霉烯类革兰氏阴性病原体（CRPs）正在成为导致医院感染的主要原因，这些感染会增加发病率、死亡率和医疗保健成本。关于儿童中 CRP 感染的信息知之甚少。
所有新发现的住院患者中由耐碳青霉烯类肺炎克雷伯菌、铜绿假单胞菌或鲍曼不动杆菌引起的感染均由希腊疾病控制和预防中心前瞻性报告。2010 年 11 月 1 日至 2012 年 3 月 30 日期间报告的所有 15 岁以下儿童耐碳青霉烯类 CRP 感染患者均纳入本研究。
2010 年 11 月至 2012 年 3 月期间，共报告 65 例儿童（中位年龄：1 岁）中 71 例 CRP 感染病例。50 例（76.9%）儿童存在基础疾病。病例包括肺炎（25 例[35.2%]，包括 20 例呼吸机相关性肺炎）、菌血症（32.4%）、尿路感染（19.7%）和手术部位感染（12.7%）。分离株为铜绿假单胞菌（41.1%）、鲍曼不动杆菌（39.7%）和肺炎克雷伯菌（19.2%）。首次阳性培养中位数发生在入院后 20 天（范围：0-313 天）。24 例（33.8%）感染发生在过去 6 个月有住院史的患者中；42 例（59.2%）和 36 例（50.7%）感染分别发生在过去 6 个月接受包括碳青霉烯类药物在内的广谱抗生素治疗的患者中。首次 CRP 阳性培养后 28 天的粗死亡率为 21.1%。
儿童中由 CRPs 引起的感染与较高的发病率和死亡率相关。
