D Yin1, L Zhang1, A Wang1, L He1, Y Cao2, F Hu3, C Wang4. 1. The Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China. 2. Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China. 3. Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China. 4. The Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China; Department of Nosocomial Infection Control, Children's Hospital of Fudan University, Shanghai, China. Electronic address: chuanqing523@163.com.
Abstract
BACKGROUND: The spread of carbapenem-resistant Klebsiella pneumoniae (CR-KPN) is a major concern, but data on CR-KPN infection/colonization in paediatric populations are limited. AIM: To analyse epidemiologic and clinical characteristics, and therapeutic options for CR-KPN infections in neonates in China. METHODS: A retrospective study was performed at the Children's Hospital of Fudan University, including 88 neonates with CR-KPN admitted between November 2015 and October 2016. Forty-seven CR-KPN isolates were chosen at random for further study, including antimicrobial susceptibility testing, potential β-lactamase screening and homology analysis. FINDINGS: In total, 44.3% (39/88) of the neonates with CR-KPN were infected, and 71.8% (28/39) were nosocomial infections. Of these, pneumonia and urinary tract infection accounted for 50.0% (14/28) and 42.9% (12/28), respectively. All infected patients were cured or improved with fosfomycin and/or carbapenem-containing combination therapy, except one case in whom treatment was withdrawn. All 47 cases of CR-KPN were resistant to ertapenem and 95.7% were resistant to imipenem/meropenem. Overall, 87.2% (41/47) were positive for blaNDM-1, and belonged to 11 pulsed-field gel electrophoresis types; 53.7% (22/41) were designated as ST278 and 17.1% (7/41) were designated as ST2735 by multi-locus sequence typing. CONCLUSIONS: Most of the CR-KPN isolated from neonates produced New Delhi metallo-beta-lactamase-1 and were highly homologous. Fosfomycin-containing regimens and meropenem-/panipenem-containing combination therapy were efficient for CR-KPN infection in neonates.
BACKGROUND: The spread of carbapenem-resistant Klebsiella pneumoniae (CR-KPN) is a major concern, but data on CR-KPN infection/colonization in paediatric populations are limited. AIM: To analyse epidemiologic and clinical characteristics, and therapeutic options for CR-KPN infections in neonates in China. METHODS: A retrospective study was performed at the Children's Hospital of Fudan University, including 88 neonates with CR-KPN admitted between November 2015 and October 2016. Forty-seven CR-KPN isolates were chosen at random for further study, including antimicrobial susceptibility testing, potential β-lactamase screening and homology analysis. FINDINGS: In total, 44.3% (39/88) of the neonates with CR-KPN were infected, and 71.8% (28/39) were nosocomial infections. Of these, pneumonia and urinary tract infection accounted for 50.0% (14/28) and 42.9% (12/28), respectively. All infectedpatients were cured or improved with fosfomycin and/or carbapenem-containing combination therapy, except one case in whom treatment was withdrawn. All 47 cases of CR-KPN were resistant to ertapenem and 95.7% were resistant to imipenem/meropenem. Overall, 87.2% (41/47) were positive for blaNDM-1, and belonged to 11 pulsed-field gel electrophoresis types; 53.7% (22/41) were designated as ST278 and 17.1% (7/41) were designated as ST2735 by multi-locus sequence typing. CONCLUSIONS: Most of the CR-KPN isolated from neonates produced New Delhi metallo-beta-lactamase-1 and were highly homologous. Fosfomycin-containing regimens and meropenem-/panipenem-containing combination therapy were efficient for CR-KPN infection in neonates.