Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Antimicrob Agents Chemother. 2017 Nov 22;61(12). doi: 10.1128/AAC.01440-17. Print 2017 Dec.
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.
耐碳青霉烯肠杆菌（CRE）在美国儿童中日益被发现，但有关该人群中 CRE 的流行病学数据有限。本研究的目的是确定 CRE 定植或感染的危险因素，并描述儿科 CRE 分离株的微生物学特征。我们于 2011 年 1 月至 2015 年 10 月在三家三级儿童护理中心进行了一项多中心病例对照研究。病例患者是从临床培养物中分离出 CRE 的住院儿童，并与 2:1 比例的耐碳青霉烯敏感（CSE）对照患者相匹配。然后使用多变量条件逻辑回归评估 CRE 定植或感染的危险因素。此外，我们全面报告了 CRE 分离株的抗菌药物敏感性模式。确定了 63 例病例患者，并与 126 例对照患者相匹配。多变量分析显示，在过去 3 个月内使用抗假单胞菌抗生素（比值比 [OR]，5.20；95%置信区间 [CI]，1.71 至 15.9；P = 0.004）、既往手术（OR，6.30；95%CI，1.83 至 21.6；P = 0.003）和机械通气（OR，12.4；95%CI，1.26 至 122；P = 0.031）是 CRE 定植或感染的危险因素。儿科 CRE 分离株对阿米卡星（5%）和环丙沙星（25%）的耐药率相对较低。我们的研究结果支持抗生素管理干预措施的重要作用，这些措施限制了不必要的抗假单胞菌抗生素的使用，是预防儿童中广泛出现 CRE 的策略。未来的研究应进一步确定儿科 CRE 分离株中抗生素耐药的分子决定因素。
