M F Ara-Montojo1, L Escosa-García1,2, M Alguacil-Guillén3, N Seara3, C Zozaya4, D Plaza5, C Schuffelmann-Gutiérrez6, Á de la Vega7, C Fernández-Camblor8, E Ramos-Boluda9, M P Romero-Gómez3, G Ruiz-Carrascoso3, I Losantos-García10, M J Mellado-Peña1,2, R Gómez-Gil3. 1. Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain. 2. RITIP (Red de Investigación Translacional en Infectología Pediátrica), Spain. 3. Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain. 4. Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain. 5. Department of Paediatric Haematology and Oncology, Hospital Universitario La Paz, Madrid, Spain. 6. Paediatric Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. 7. Department of Hepatology and Liver Transplantation, Hospital Universitario La Paz, Madrid, Spain. 8. Department of Nephrology and Kidney Transplantation, Hospital Universitario La Paz, Madrid, Spain. 9. Paediatric Intestinal Rehabilitation and Bowel Transplantation, Hospital Universitario La Paz, Madrid, Spain. 10. Department of Biostatistics, Hospital Universitario La Paz, Madrid, Spain.
Abstract
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). OBJECTIVES: To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. METHODS: A retrospective observational single-centre study (December 2005-August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. RESULTS: Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P < 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. CONCLUSIONS: CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.
BACKGROUND:Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). OBJECTIVES: To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. METHODS: A retrospective observational single-centre study (December 2005-August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. RESULTS: Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P < 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. CONCLUSIONS: CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.
Authors: Lorenzo Onorato; Bruno Sarnelli; Federica D'Agostino; Giuseppe Signoriello; Ugo Trama; Angelo D'Argenzio; Maria Vittoria Montemurro; Nicola Coppola Journal: Antibiotics (Basel) Date: 2022-05-08
Authors: Richard C Franzese; Lynn McFadyen; Kenny J Watson; Todd Riccobene; Timothy J Carrothers; Manoli Vourvahis; Phylinda L S Chan; Susan Raber; John S Bradley; Mark Lovern Journal: Clin Pharmacol Ther Date: 2021-11-22 Impact factor: 6.903