Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Department of Pediatrics, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
J Korean Med Sci. 2022 Jun 20;37(24):e196. doi: 10.3346/jkms.2022.37.e196.
infections cause high morbidity and mortality in intensive care unit (ICU) patients. However, there are limited data on the changes of long-term epidemiology of imipenem resistance in bacteremia among pediatric ICU (PICU) patients.
A retrospective review was performed on patients with bacteremia in PICU of a tertiary teaching hospital from 2000 to 2016. Antimicrobial susceptibility tests, multilocus sequence typing (MLST), and polymerase chain reaction for antimicrobial resistance genes were performed for available isolates.
bacteremia occurred in 27 patients; imipenem-sensitive (ISAB, n = 10, 37%) and imipenem-resistant (IRAB, n = 17, 63%). There was a clear shift in the antibiogram of during the study period. From 2000 to 2003, all isolates were ISAB (n = 6). From 2005 to 2008, both IRAB (n = 5) and ISAB (n = 4) were isolated. However, from 2009, all isolates were IRAB (n = 12). Ten isolates were available for additional test and confirmed as IRAB. MLST analysis showed that among 10 isolates, sequence type 138 was predominant (n = 7). All 10 isolates were positive for OXA-23-like and OXA-51-like carbapenemase. Of 27 bacteremia patients, 11 were male (41%), the median age at bacteremia onset was 5.2 years (range, 0-18.6 years). In 33% (9/27) of patients, was isolated from tracheal aspirate prior to development of bacteremia (median, 8 days; range, 5-124 days). The overall case-fatality rate was 63% (17/27) within 28 days. There was no statistical difference in the case fatality rate between ISAB and IRAB groups (50% vs. 71%; = 0.422).
IRAB bacteremia causes serious threat in patients in PICU. Proactive infection control measures and antimicrobial stewardship are crucial for managing IRAB infection in PICU.
感染会导致重症监护病房（ICU）患者的高发病率和死亡率。然而，关于儿童 ICU（PICU）患者血流感染中碳青霉烯类耐药的长期流行病学变化的数据有限。
对 2000 年至 2016 年期间在一家三级教学医院 PICU 发生血流感染的患者进行回顾性分析。对可获得的分离株进行抗菌药敏试验、多位点序列分型（MLST）和耐药基因聚合酶链反应。
27 例患者发生血流感染；其中对亚胺培南敏感（ISAB，n = 10，37%）和对亚胺培南耐药（IRAB，n = 17，63%）。在研究期间，药敏谱发生了明显变化。2000 年至 2003 年，所有分离株均为 ISAB（n = 6）。2005 年至 2008 年，IRAB（n = 5）和 ISAB（n = 4）均有分离。然而，自 2009 年以来，所有分离株均为 IRAB（n = 12）。10 株分离株可进行进一步检测，并确认为 IRAB。MLST 分析显示，10 株分离株中，以 138 型为主（n = 7）。10 株分离株均对 OXA-23 样和 OXA-51 样碳青霉烯酶呈阳性。27 例血流感染患者中，11 例为男性（41%），血流感染发病中位年龄为 5.2 岁（范围 0-18.6 岁）。33%（9/27）的患者在血流感染发生前从气管吸出物中分离出（中位时间为 8 天；范围 5-124 天）。28 天内的总病死率为 63%（17/27）。ISAB 和 IRAB 组的病死率无统计学差异（50%比 71%；= 0.422）。
IRAB 血流感染对 PICU 患者构成严重威胁。主动感染控制措施和抗菌药物管理对管理 PICU 中的 IRAB 感染至关重要。
