Avcu Gulhadiye, Erci Ece, Bilen Nimet Melis, Ersayoglu Irem, Ozek Gulcihan, Celtik Ulgen, Terek Demet, Cilli Feriha, Bal Zumrut Sahbudak
Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Ege University, Izmir, Turkey.
Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care, Ege University, Izmir, Turkey.
J Antimicrob Chemother. 2025 Jan 3;80(1):147-153. doi: 10.1093/jac/dkae387.
The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections among children represents a significant global concern, leading to elevated mortality rates. The aim of this study was to evaluate the risk factors, outcomes, 30-day mortality rates and contributing factors in children with CRE bloodstream infections (CRE-BSIs).
Data regarding demographic characteristics, treatment approaches and outcomes of hospitalized children aged 0-18 years diagnosed with CRE-BSIs between January 2018 and December 2022 were extracted from medical records. Mortality within 30 days of diagnosis and the predictive factors were analysed.
A total of 114 children, with a median age of 11 months (range: 6-69.5), were included. All cases of CRE-BSIs were either healthcare associated or hospital acquired and presented with at least one underlying comorbidity. A previous history of CRE colonization or infection rate was 48.2% (55/114). Klebsiella pneumoniae 87.7% (100/114) was the most frequently isolated microorganism, with a 30-day mortality rate of 14% (16/114). Multivariate analysis identified paediatric intensive care unit admission, invasive mechanical ventilation, inotropic support and thrombocytopenia due to CRE-BSIs as the most discriminative predictors for 30-day mortality (P < 0.001). Central venous catheter (CVC) removal was associated with a reduced mortality rate (P = 0.012). High-dose prolonged infusion of MEM-based or polymyxin-based antibiotic combinations did not impact survival. Lower MEM MIC values were associated with improved survival.
The mortality rate of CRE-BSI is notably high in childhood. The use of antibiotic combination strategies did not demonstrate a significant impact on 30-day survival; however, the removal of CVCs was found to lower mortality rates.
耐碳青霉烯类肠杆菌科细菌（CRE）感染在儿童中的患病率不断上升，这是一个重大的全球问题，导致死亡率升高。本研究的目的是评估儿童CRE血流感染（CRE-BSIs）的危险因素、结局、30天死亡率及相关因素。
从2018年1月至2022年12月期间诊断为CRE-BSIs的0至18岁住院儿童的病历中提取有关人口统计学特征、治疗方法和结局的数据。分析诊断后30天内的死亡率及预测因素。
共纳入114名儿童，中位年龄为11个月（范围：6至69.5个月）。所有CRE-BSIs病例均为医疗相关或医院获得性感染，且至少有一种基础合并症。既往有CRE定植或感染史的比例为48.2%（55/114）。肺炎克雷伯菌87.7%（100/114）是最常分离出的微生物，30天死亡率为14%（16/114）。多变量分析确定儿科重症监护病房入院、有创机械通气、血管活性药物支持以及CRE-BSIs导致的血小板减少是30天死亡率最具鉴别力的预测因素（P<0.001）。拔除中心静脉导管（CVC）与死亡率降低相关（P=0.012）。基于美罗培南或基于多粘菌素的抗生素组合的大剂量延长输注对生存无影响。较低的美罗培南最低抑菌浓度（MIC）值与生存改善相关。
儿童CRE-BSI的死亡率显著较高。抗生素联合策略的使用对30天生存率未显示出显著影响；然而，发现拔除CVC可降低死亡率。
