The prospective evaluation of risk factors and clinical influence of carbapenem resistance in children with gram-negative bacteria infection

Published:October 02, 2017DOI:


      Carbapenem-resistant gram-negative (CRGN) infections have been increasing in recent years and associated with significant morbidity, mortality, and health care costs. The aim of this study was to evaluate the epidemiologic and clinical risk characteristics, risk factors, and outcome of CRGN infections and to compare with carbapenem-sensitive gram-negative (CSGN) infections in children.


      Newly diagnosed CRGN infections in hospitalized children younger than age 18 years were prospectively recorded and all patients infected with a CSGN pathogen in the same unit within 48 hours of diagnosis were included in a control group between April 1, 2014, and December 31, 2014.


      Twenty-seven patients with CRGN infections and 28 patients with CSGN infections were enrolled in this study. Ventilator-associated pneumonia was the most common type of infection in both groups. Prior exposure to carbapenems (relative risk [RR], 11.368; 95% confidence interval [CI], 1.311-98.589), prolonged hospitalization (RR, 5.100; 95% CI, 1.601-16.242) were found to be independent risk factors for acquiring CRGN infections. Septic shock was significantly more frequent in the CRGN group (RR, 9.450; 95% CI, 1.075-83.065). The in-hospital mortality was higher in the CRGN group (RR, 7.647; 95% CI, 1.488-39.290).


      Prior carbapenem exposure and prolonged hospitalization are the most important risk factors for acquiring CRGN infections in our hospital. This study demonstrated, similar to previous reports, that carbapenem resistance increases morbidity, mortality, and health care costs.

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        • MacVane S.H.
        Antimicrobial resistance in the intensive care unit: a focus on Gram-negative bacterial infections.
        J Intensive Care Med. 2017; 32: 25-37
        • Kaye K.S.
        • Pogue J.M.
        Infections caused by resistant Gram-negative bacteria: epidemiology and management.
        Pharmacotherapy. 2015; 35: 949-962
        • Chiotos K.
        • Han J.H.
        • Tamma P.D.
        Carbapenem-resistant Enterobacteriaceae infections in children.
        Curr Infect Dis Rep. 2016; 18: 2
        • Logan L.K.
        Carbapenem-resistant Enterobacteriaceae: an emerging problem in children.
        Clin Infect Dis. 2012; 55: 852-859
        • Thatrimontrichai A.
        • Apisarnthanarak A.
        • Chanvitan P.
        • Janjindamai W.
        • Dissaneevate S.
        • Maneenil G.
        Risk factors and outcomes of carbapenem-resistant Acinetobacter baumannii bacteremia in neonatal intensive care unit: a case-case-control study.
        Pediatr Infect Dis J. 2013; 32: 140-145
        • Routsi C.
        • Pratikaki M.
        • Platsouka E.
        • Sotiropoulou C.
        • Nanas S.
        • Markaki V.
        • et al.
        Carbapenem-resistant versus carbapenem-susceptible Acinetobacter baumannii bacteremia in a Greek intensive care unit: risk factors, clinical features and outcomes.
        Infection. 2010; 38: 173-180
        • Wang Q.
        • Zhang Y.
        • Yao X.
        • Xian H.
        • Liu Y.
        • Li H.
        • et al.
        Risk factors and clinical outcomes for carbapenem-resistant Enterobacteriaceae nosocomial infections.
        Eur J Clin Microbiol Infect Dis. 2016; 35: 1679-1689
        • Maltezou H.C.
        • Kontopidou F.
        • Katerelos P.
        • Daikos G.
        • Roilides E.
        • Theodoridou M.
        Infections caused by carbapenem-resistant Gram-negative pathogens in hospitalized children.
        Pediatr Infect Dis J. 2013; 32: e151-e154
        • Leclercq R.
        • Cantón R.
        • Brown D.F.
        • Giske C.G.
        • Heisig P.
        • MacGowan A.P.
        • et al.
        EUCAST expert rules in antimicrobial susceptibility testing.
        Clin Microbiol Infect. 2013; 19: 141-160
        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 36: 309-332
        • Magiorakos A.P.
        • Srinivasan A.
        • Carey R.B.
        • Carmeli Y.
        • Falagas M.E.
        • Giske C.G.
        • et al.
        Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.
        Clin Microbiol Infect. 2012; 18: 268-281
        • Logan L.K.
        • Renschler J.P.
        • Gandra S.
        • Weinstein R.A.
        • Laxminarayan R.
        • et al.
        • Centers for Disease Control
        Carbapenem-resistant Enterobacteriaceae in children, United States, 1999-2012.
        Emerg Infect Dis. 2015; 21: 2014-2021
        • Satlin M.J.
        • Cohen N.
        • Ma K.C.
        • Gedrimaite Z.
        • Soave R.
        • Askin G.
        • et al.
        Bacteremia due to carbapenem-resistant Enterobacteriaceae in neutropenic patients with hematologic malignancies.
        J Infect. 2016; 73: 336-345
        • Le N.K.
        • Hf W.
        • Vu P.D.
        • Khu D.T.
        • Le H.T.
        • Hoang B.T.
        • et al.
        High prevalence of hospital-acquired infections caused by Gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: a multi-centre point prevalence survey.
        Medicine (Baltimore). 2016; 95: e4099
        • Montagnani C.
        • Prato M.
        • Scolfaro C.
        • Colombo S.
        • Esposito S.
        • Tagliabue C.
        • et al.
        Carbapenem-resistant Enterobacteriaceae infections in children: an Italian retrospective multicenter study.
        Pediatr Infect Dis J. 2016; 35: 862-868
        • Barlam T.F.
        • Cosgrove S.E.
        • Abbo L.M.
        • MacDougall C.
        • Schuetz A.N.
        • Septimus E.J.
        • et al.
        Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.
        Clin Infect Dis. 2016; 62: e51-e77
        • Sheng W.H.
        • Liao C.H.
        • Lauderdale T.L.
        • Ko W.C.
        • Chen Y.S.
        • Liu J.W.
        • et al.
        A multicenter study of risk factors and outcome of hospitalized patients with infections due to carbapenem-resistant Acinetobacter baumannii.
        Int J Infect Dis. 2010; 14: e764-e769
        • Ozsurekci Y.
        • Aykac K.
        • Cengiz A.B.
        • Basaranoglu S.T.
        • Sancak B.
        • Karahan S.
        • et al.
        Bloodstream infections in children caused by carbapenem-resistant versus carbapenem-susceptible Gram-negative microorganisms: risk factors and outcome.
        Diagn Microbiol Infect Dis. 2017; 87 (S0732-8893(17)30001-9 [pii]): 359-364
        • Huang S.T.
        • Chiang M.C.
        • Kuo S.C.
        • Lee Y.T.
        • Chiang T.H.
        • Yang S.P.
        • et al.
        Risk factors and clinical outcomes of patients with carbapenem-resistant Acinetobacter baumannii bacteremia.
        J Microbiol Immunol Infect. 2012; 45: 356-362
        • Tacconelli E.
        • Cataldo M.A.
        • Dancer S.J.
        • De Angelis G.
        • Falcone M.
        • Frank U.
        • et al.
        ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients.
        Clin Microbiol Infect. 2014; 20: 1-55
        • Cho O.H.
        • Bak M.H.
        • Baek E.H.
        • Park K.H.
        • Kim S.
        • Bae I.G.
        Successful control of carbapenem-resistant Acinetobacter baumannii in a Korean university hospital: a 6-year perspective.
        Am J Infect Control. 2014; 42: 976-979

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