Department of Laboratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China.
Front Public Health. 2023 Feb 9;11:1088262. doi: 10.3389/fpubh.2023.1088262. eCollection 2023.
Carbapenem-resistant (CRPA) is a major cause of healthcare-associated infections worldwide, but comprehensive study of clinical characteristics for CRPA infections among critically ill children remains limited in China. The objective of this study was to determine the epidemiology, risk factors, and clinical outcomes of CRPA infections among critically ill pediatric patients in a large tertiary pediatric hospital in China.
A retrospective case-control study of patients with infections was conducted in the three intensive care units (ICUs) of Shanghai Children's Medical Center from January 2016 to December 2021. All patients with CRPA infection in the ICUs were enrolled as case patients. Patients with carbapenem-susceptible (CSPA) infection were randomly selected as control patients in a ratio of 1:1. Clinical characteristics of those inpatients were reviewed through the hospital information system. Univariate and multivariate analyses were performed to evaluate risk factors associated with the development of CRPA infections and mortality of infections.
A total of 528 cases of infection in the ICUs were enrolled in the 6-year study. The prevalence of CRPA and MDRPA (multidrug-resistance ) was 18.4 and 25.6%, respectively. Significant risk factors related to CRPA infection were the length of hospitalization >28 days (OR = 3.241, 95% CI 1.622-6.473, = 0.001), receiving invasive operations (OR = 2.393, 95% CI 1.196-4.788, = 0.014) and a blood transfusion (OR = 7.003, 95% CI 2.416-20.297, < 0.001) within 30 days before infection. Conversely, birth weight ≥2,500 g (OR = 0.278, 95% CI 0.122-0.635, = 0.001) and breast nursing (OR = 0.362, 95% CI 0.168-0.777, = 0.009) were significant protective factors against CRPA infections. The in-hospital mortality rate was 14.2%, and no difference in mortality was observed between patients with CRPA and CSPA infections. Platelet < 100 × 10/L (OR = 5.729, 95% CI 1.048-31.308, = 0.044) and serum urea <3.2 mmol/L (OR = 5.173, 95% CI 1.215-22.023, = 0.026) were independent predictors for the mortality due to infection.
Our findings provide insights into CRPA infections among critically ill children in China. They provide guidance in identifying patients that may be at high risk for a resistant infection and emphasize the importance of antimicrobial stewardship and infection control in hospitals.
耐碳青霉烯肠杆菌（CRPA）是全球医源性感染的主要原因，但中国对危重症患儿 CRPA 感染的临床特征进行综合研究仍然有限。本研究旨在确定中国一家大型儿科医院重症监护病房（ICU）中 CRPA 感染的流行病学、危险因素和临床结果。
对 2016 年 1 月至 2021 年 12 月上海儿童医学中心 3 个 ICU 中 的感染患者进行回顾性病例对照研究。所有 ICU 中 CRPA 感染的患者均被纳入病例组。按照 1:1 的比例随机选择碳青霉烯敏感 的（CSPA）感染患者作为对照组。通过医院信息系统回顾住院患者的临床特征。采用单因素和多因素分析评估与 CRPA 感染发展和 感染死亡率相关的危险因素。
在 6 年的研究中，共纳入 528 例 ICU 中 的感染患者。CRPA 和 MDRPA（多重耐药）的患病率分别为 18.4%和 25.6%。与 CRPA 感染相关的显著危险因素包括住院时间＞28 天（OR=3.241，95%CI 1.622-6.473，=0.001）、接受侵入性操作（OR=2.393，95%CI 1.196-4.788，=0.014）和输血（OR=7.003，95%CI 2.416-20.297，＜0.001）在感染前 30 天内。相反，出生体重≥2500 g（OR=0.278，95%CI 0.122-0.635，=0.001）和母乳喂养（OR=0.362，95%CI 0.168-0.777，=0.009）是 CRPA 感染的显著保护因素。住院死亡率为 14.2%，CRPA 和 CSPA 感染患者的死亡率无差异。血小板＜100×10/L（OR=5.729，95%CI 1.048-31.308，=0.044）和血清尿素＜3.2 mmol/L（OR=5.173，95%CI 1.215-22.023，=0.026）是 感染死亡的独立预测因素。
本研究结果为中国危重症患儿 CRPA 感染提供了新的认识。这些发现为识别可能存在耐药感染风险的患者提供了指导，并强调了抗菌药物管理和医院感染控制的重要性。
