Nabarro Laura E B, Shankar Chaitra, Pragasam Agila K, Mathew Georgekutty, Jeyaseelan Visali, Veeraraghavan Balaji, Verghese Valsan P
From the *Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India; †Public Health England, London, United Kingdom; ‡Department of Biostatistics, and §Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
Pediatr Infect Dis J. 2017 Jun;36(6):e161-e166. doi: 10.1097/INF.0000000000001499.
Carbapenem-resistant Enterobacteriaceae (CRE) are an increasing cause of nosocomial infection in hospitalized children worldwide. Few studies have investigated risk factors for mortality in children with CRE bloodstream infection (BSI). Data are particularly scarce in areas where NDM and OXA carbapenemases predominate. Here, we investigate mortality rates, clinical and microbiologic risk factors for mortality in 50 pediatric patients with CRE BSI in India.
Children younger than 17 years old with meropenem-resistant Klebsiella pneumoniae or Escherichia coli isolated from blood culture in 2014 and 2015 were identified from laboratory records. Clinical records were systematically reviewed for each child to establish mortality at 30 days and clinical details. Bacterial isolates were subjected to meropenem E test and multiplex polymerase chain reaction to determine carbapenemase gene. Data were analyzed to establish clinical and bacterial risk factors for mortality.
All CRE BSI were hospital-acquired or associated with healthcare. A total of 84% of children had an underlying comorbidity and 46% had a malignancy. K. pneumoniae was the most common bacteria isolated; NDM was the most common carbapenemase gene detected. The mortality rate was 52%. Significant risk factors for mortality included intensive care admission, intubation, inotropic support and respiratory source. Failure to clear bacteremia and a minimum inhibitory concentration > 8 mg/L for the isolate was associated with a statistically significant increase in mortality. Mortality rates were significantly lower when two or more effective drugs were used in combination.
CRE BSI affects children with multiple comorbidities and repeated admissions to hospital. The mortality rate is high; combination therapy may be beneficial.
耐碳青霉烯类肠杆菌科细菌（CRE）是全球住院儿童医院感染日益增加的一个原因。很少有研究调查CRE血流感染（BSI）患儿的死亡风险因素。在以新德里金属β-内酰胺酶（NDM）和OXA碳青霉烯酶为主的地区，数据尤其匮乏。在此，我们调查了印度50例CRE BSI儿科患者的死亡率、死亡的临床和微生物风险因素。
从实验室记录中识别出2014年和2015年血液培养分离出耐美罗培南肺炎克雷伯菌或大肠埃希菌的17岁以下儿童。系统回顾每个儿童的临床记录以确定30天死亡率和临床细节。对细菌分离株进行美罗培南E试验和多重聚合酶链反应以确定碳青霉烯酶基因。分析数据以确定死亡的临床和细菌风险因素。
所有CRE BSI均为医院获得性或与医疗保健相关。共有84%的儿童有潜在合并症，46%的儿童患有恶性肿瘤。肺炎克雷伯菌是最常见的分离细菌；NDM是检测到的最常见的碳青霉烯酶基因。死亡率为52%。死亡的显著风险因素包括入住重症监护病房、插管、使用血管活性药物支持和呼吸道感染源。未能清除菌血症以及分离株的最低抑菌浓度>8mg/L与死亡率的统计学显著增加相关。联合使用两种或更多有效药物时死亡率显著降低。
CRE BSI影响有多种合并症且多次住院的儿童。死亡率很高；联合治疗可能有益。
