Liang Yujian, Zhao Chenfeng, Lu Yuhang, Liao Kang, Kong Yannan, Hong Mengzhi, Li Liubing, Chen Yili
Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510080, People's Republic of China.
Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, People's Republic of China.
Infect Drug Resist. 2024 Nov 2;17:4815-4823. doi: 10.2147/IDR.S485001. eCollection 2024.
Carbapenem-resistant (CRE) is rapidly becoming a major threat to hospitalized children worldwide. The purpose of this study was to summarize etiological characteristics and identify risk factors relevant to CRE bloodstream infection (BSI) and short-term mortality among pediatric patients in China.
In this study, we included 370 inpatients ≤17 years old with BSI caused by in China from January 2013 to December 2022. By collecting data on demographics, etiological features, and clinical outcomes, we conducted an in-depth analysis.
Among the 370 BSI patients with infections caused by , 35 patients (9.46%) were caused by CRE. Among these CRE strains, (49.46%) was the most important pathogen of BSI in pediatric patients, followed by (31.62%) and (5.95%). The most frequent carbapenemase was NDM (23/35, 65.71%), followed by KPC (8/35, 22.86%). The overall 28-day mortality rate of children with an BSI episode was 1.89% (7/370), of which CRE BSI patients (3/35, 8.57%) were significantly higher than CSE patients (4/335, 1.19%, P < 0.001). Congenital malformation (OR: 8.162, 95% CI: 3.859-16.680, P < 0.001) and catheter-related (OR: 6.645, 95% CI: 3.159-13.28, P: <0.001) were associated with the development of CRE BSI in pediatric patients. A multivariate analysis showed that the infection of CRE (OR 7.758, 95% CI 1.869-29.62, P = 0.021) were independent risk factors for 28-day mortality of BSI. When the MIC of any carbapenems was ≥8 μg/mL, the mortality rate in the ICU was higher (P < 0.05).
Congenital malformation, previous cephalosporin/carbapenems administration, and catheter-related conditions were closely related to the development of CRE BSI. The mortality rate of CRE BSI was higher. NDM was the predominant carbapenemase-producing mechanism in children.
耐碳青霉烯类肠杆菌科细菌（CRE）正迅速成为全球住院儿童面临的重大威胁。本研究旨在总结中国儿科患者CRE血流感染（BSI）的病因特征，并确定与CRE BSI及短期死亡率相关的危险因素。
本研究纳入了2013年1月至2022年12月在中国因BSI住院的370例17岁及以下患者。通过收集人口统计学、病因特征和临床结局数据，我们进行了深入分析。
在370例由[未提及具体病原体名称]引起感染的BSI患者中，35例（9.46%）由CRE引起。在这些CRE菌株中，[未提及具体病原体名称]（49.46%）是儿科患者BSI最重要的病原体，其次是[未提及具体病原体名称]（31.62%）和[未提及具体病原体名称]（5.95%）。最常见的碳青霉烯酶是NDM（23/35，65.71%），其次是KPC（8/35，22.86%）。BSI发作的儿童总体28天死亡率为1.89%（7/370），其中CRE BSI患者（3/35，8.57%）显著高于碳青霉烯敏感肠杆菌科细菌（CSE）患者（4/335，1.19%，P<0.001）。先天性畸形（OR：8.162，95%CI：3.859 - 16.680，P<0.001）和导管相关（OR：6.645，95%CI：3.159 - 13.28，P：<0.001）与儿科患者CRE BSI的发生有关。多因素分析显示，CRE感染（OR 7.758，95%CI 1.869 - 29.62，P = 0.021）是BSI 28天死亡率的独立危险因素。当任何碳青霉烯类药物的最低抑菌浓度（MIC）≥8μg/mL时，重症监护病房（ICU）的死亡率更高（P<0.05）。
先天性畸形、既往头孢菌素/碳青霉烯类药物使用以及导管相关情况与CRE BSI的发生密切相关。CRE BSI的死亡率较高。NDM是儿童中主要的产碳青霉烯酶机制。
