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Girona‐Alarcón M, Fresán E, Garcia‐Garcia A, Bobillo‐Perez S, Balaguer M, Felipe A, Esteban ME, Jordan I. Device-associated multidrug-resistant bacteria surveillance in critically ill children: 10 years of experience. Acta Paediatr 2021; 110:203-209. [PMID: 32383199 DOI: 10.1111/apa.15342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
AIM Multidrug-resistant bacterial infections are a public health problem worldwide. However, most of the information available refers to adults. The main objectives were to determine the incidence, risk factors, and outcomes for device-associated infections, especially those involving multidrug-resistant bacteria. METHODS This is a prospective, observational study. Children aged ≥1 month and <18 years admitted to the paediatric intensive care unit from 2008 to 2017, with a device-associated infection microbiologically confirmed were included. Patients infected with resistant bacteria were compared with those who had a drug-susceptible infection. RESULTS The study included 213 patients. Out of all the device-associated infections, 22% (48 patients) were caused by multidrug-resistant bacteria. The most frequent were extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Cardiovascular diseases, age under 1year, comorbidity, prolonged use of invasive device, and length of stay until infection were risk factors for resistant bacteria, but not specifically for ESBL-producing bacteria. Length of stay and mortality was increased in patients with multidrug-resistant bacteria. CONCLUSION Being under 1-year-old and having a cardiovascular disease were the two major risk factors for resistant bacterial infection. ESBL-producing bacteria were the most frequent multidrug-resistant agents. However, patients with ESBL-producing bacteria did not have any additional risk factors, so they may have been colonised in the community.
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Affiliation(s)
- Mònica Girona‐Alarcón
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Elena Fresán
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Ana Garcia‐Garcia
- Immunology Department Hospital Sant Joan de Déu‐Clínic University of Barcelona Barcelona Spain
| | - Sara Bobillo‐Perez
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Monica Balaguer
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Aida Felipe
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Maria Esther Esteban
- Zoology and Anthropology Section Department of Evolutionary Biology, Ecology and Environmental Sciences Faculty of Biology GREAB‐ Biological Anthropology Research Group Institut de Recerca de la Biodiversitat (IRBio) University of Barcelona Barcelona Spain
| | - Iolanda Jordan
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
- Paediatric Intensive Care Unit CIBERESP, Hospital Sant Joan de Déu‐Clínic University of Barcelona Barcelona Spain
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Malchione MD, Torres LM, Hartley DM, Koch M, Goodman JL. Carbapenem and colistin resistance in Enterobacteriaceae in Southeast Asia: Review and mapping of emerging and overlapping challenges. Int J Antimicrob Agents 2019; 54:381-399. [DOI: 10.1016/j.ijantimicag.2019.07.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 01/21/2023]
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Mohd Rani F, A Rahman NI, Ismail S, Alattraqchi AG, Cleary DW, Clarke SC, Yeo CC. Acinetobacter spp. Infections in Malaysia: A Review of Antimicrobial Resistance Trends, Mechanisms and Epidemiology. Front Microbiol 2017; 8:2479. [PMID: 29312188 PMCID: PMC5733036 DOI: 10.3389/fmicb.2017.02479] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022] Open
Abstract
Acinetobacter spp. are important nosocomial pathogens, in particular the Acinetobacter baumannii-calcoaceticus complex, which have become a global public health threat due to increasing resistance to carbapenems and almost all other antimicrobial compounds. High rates of resistance have been reported among countries in Southeast Asia, including Malaysia. In this review, we examine the antimicrobial resistance profiles of Acinetobacter spp. hospital isolates from Malaysia over a period of nearly three decades (1987–2016) with data obtained from various peer-reviewed publications as well as the Malaysian National Surveillance on Antibiotic Resistance (NSAR). NSAR data indicated that for most antimicrobial compounds, including carbapenems, the peak resistance rates were reached around 2008–2009 and thereafter, rates have remained fairly constant (e.g., 50–60% for carbapenems). Individual reports from various hospitals in Peninsular Malaysia do not always reflect the nationwide resistance rates and often showed higher rates of resistance. We also reviewed the epidemiology and mechanisms of resistance that have been investigated in Malaysian Acinetobacter spp. isolates, particularly carbapenem resistance and found that blaOXA-23 is the most prevalent acquired carbapenemase-encoding gene. From the very few published reports and whole genome sequences that are available, most of the Acinetobacter spp. isolates from Malaysia belonged to the Global Clone 2 (GC2) CC92 group with ST195 being the predominant sequence type. The quality of data and analysis in the national surveillance reports could be improved and more molecular epidemiology and genomics studies need to be carried out for further in-depth understanding of Malaysian Acinetobacter spp. isolates.
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Affiliation(s)
- Farahiyah Mohd Rani
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Nor Iza A Rahman
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Salwani Ismail
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | | | - David W Cleary
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Stuart C Clarke
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom.,Global Health Research Institute, University of Southampton, Southampton, United Kingdom.,International Medical University, Kuala Lumpur, Malaysia
| | - Chew Chieng Yeo
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
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Yue D, Song C, Zhang B, Liu Z, Chai J, Luo Y, Wu H. Hospital-wide comparison of health care-associated infection among 8 intensive care units: A retrospective analysis for 2010-2015. Am J Infect Control 2017; 45:e7-e13. [PMID: 27856076 DOI: 10.1016/j.ajic.2016.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Exploring the distribution of nosocomial pathogens among different categories of intensive care units (ICUs) is critical to improving the management of health care-associated infection (HAI). Despite both single- and multicenter studies, the nature of the variations of HAIs within various ICUs remains inadequately evaluated. METHODS Data on HAIs at our hospital during the period January 2010-December 2015 were collected from 8 ICUs, namely, respiratory, cardiovascular, neurology, neonatal, hematology, emergency, cardiothoracic surgery, and neurosurgery ICUs, at a tertiary hospital. RESULTS We observed a cumulative HAI incidence of 15.6/1,000 patient-days among 6,254 cases of infection at the hospital, as well as obvious interunit variations in HAI distribution. Acinetobacter baumannii was the leading organism of infection in almost every ICU, especially in emergency, neurosurgery, and neonatal ICUs. The most common pathogens were Pseudomonas aeruginosa in the cardiothoracic surgery, emergency, and neonatal ICUs; Klebsiella pneumoniae and Escherichia coli in the neurosurgery, emergency, neonatal, and neurology ICUs; and Candida albicans in both neurology and emergency ICUs. CONCLUSIONS Our findings revealed that A baumannii and P aeruginosa were the most common pathogens associated with invasive operations, whereas K pneumoniae and E coli were the most common pathogens in the medical ICUs.
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Yap PSX, Ahmad Kamar A, Chong CW, Yap IKS, Thong KL, Choo YM, Md Yusof MY, Teh CSJ. Intestinal carriage of multidrug-resistant gram-negative bacteria in preterm-infants during hospitalization in neonatal intensive care unit (NICU). Pathog Glob Health 2016; 110:238-246. [PMID: 27650884 DOI: 10.1080/20477724.2016.1229884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The prevalence and antibiotic susceptibility of intestinal carriage of Gram-negative bacteria among preterm infants admitted to the neonatal intensive care unit (NICU) in a tertiary teaching hospital in Malaysia were determined. A total of 34 stool specimens were obtained from preterm infants upon admission and once weekly up to two weeks during hospitalization. The presumptive colonies of Escherichia coli and Klebsiella pneumoniae were selected for identification, antibiotic susceptibility testing, and subtyping by using pulsed-field gel electrophoresis (PFGE). Out of 76 Gram-negative isolates, highest resistance was detected for amoxicillin/clavulanate (30.8%, n = 16), ceftriaxone (42.3%, n = 22), ceftazidime (28.8%, n = 15), cefoxitin (28.8%, n = 15), aztreonam (36.5%, n = 19), and polymyxin B (23.1%, n = 12). Three colistin resistant K. pneumoniae have also been detected based on E-test analysis. Thirty-nine isolates of K. pneumoniae and 20 isolates of E. coli were resistant to more than three antimicrobial classes and were categorized as multidrug resistant (MDR). PFGE analysis revealed a higher diversity in pulsotypes for K. pneumoniae (18 pulsotypes) in comparison to E. coli (four pulsotypes). In addition, a total of fifteen pulsotypes was observed from 39 MDR K. pneumoniae. The risk factors for antibiotic resistance were assessed using random forest analysis. Gender was found to be the most important predictor for colistin resistant while length, OFC, and delivery mode were showing greater predictive power in the polymyxin B resistance. This study revealed worrying prevalence rates of intestinal carriage of multidrug-resistant K. pneumoniae and E. coli of hospitalized preterm infants in Malaysia, particularly high resistance to polymyxins.
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Affiliation(s)
- Polly Soo Xi Yap
- a Department of Medical Microbiology, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia
| | - Azanna Ahmad Kamar
- b Department of Paediatrics, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia
| | - Chun Wie Chong
- c Department of Life Sciences, School of Pharmacy , International Medical University , 57000 Kuala Lumpur , Malaysia
| | - Ivan Kok Seng Yap
- c Department of Life Sciences, School of Pharmacy , International Medical University , 57000 Kuala Lumpur , Malaysia
| | - Kwai Lin Thong
- d Institute of Biological Sciences, Faculty of Science , University of Malaya , 50603 Kuala Lumpur , Malaysia
| | - Yao Mun Choo
- b Department of Paediatrics, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia
| | - Mohd Yasim Md Yusof
- a Department of Medical Microbiology, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia
| | - Cindy Shuan Ju Teh
- a Department of Medical Microbiology, Faculty of Medicine , University of Malaya , 50603 Kuala Lumpur , Malaysia
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Izadpour F, Ranjbari N, Aramesh MR, Moosavian M, ShahAli S, Larki F, Tabesh H, Morvaridi A. An Investigation of Antibacterial Resistance Patterns Among Acinetobacter baumannii and Pseudomonas aeruginosa Isolates Collected from Intensive Care Units of a University-Affiliated Hospital in Ahvaz, Iran. Jundishapur J Microbiol 2016; 9:e35624. [PMID: 27800136 PMCID: PMC5080913 DOI: 10.5812/jjm.35624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 07/13/2016] [Accepted: 08/09/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In recent decades, multidrug-resistant non-fermenting Gram-negative pathogens, particularly Acinetobacter baumannii and Pseudomonas aeruginosa, have been recognized as a major cause of healthcare-associated and nosocomial infections and outbreaks. OBJECTIVES The aim of this study was to determine the prevalence and pattern of antibiotic resistance in A. baumannii and P. aeruginosa isolates collected from intensive care units (ICUs). METHODS One hundred fifty-five clinical isolates, including 80 (51.6%) isolates of A. baumannii and 75 (48.4%) isolates of P. aeruginosa, from hospitalized patients in the ICUs of a teaching hospital in Ahvaz, Iran, were collected from January 1 to December 30, 2013. The organisms were identified with conventional bacteriological methods, and antimicrobial susceptibility testing was performed on all isolates in accordance with clinical laboratory and standards institute (CLSI) guidelines. RESULTS The maximum resistance rates among A. baumannii isolates were observed for ciprofloxacin and trimethoprim-sulfamethoxazole (96.9% and 95.2%, respectively). For P. aeruginosa isolates, the maximum resistance rates were reported for ceftriaxone and trimethoprim-sulfamethoxazole (97.2% and 92.4%, respectively). CONCLUSIONS The majority of A. baumannii and P. aeruginosa isolates were found to be resistant to commonly recommended antibiotics. Therefore, surveillance of antibiotic consumption and proper antibiotic administration guidelines are essential for preventing major outbreaks in the future.
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Affiliation(s)
- Farrokh Izadpour
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Nastaran Ranjbari
- Department of Pathology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mohammad-Reza Aramesh
- Neonatal Intensive Care Unit (NICU), Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mojtaba Moosavian
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Shiva ShahAli
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding author: Shiva ShahAli, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6133337681, E-mail:
| | - Farzaneh Larki
- Department of Pathology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Hamed Tabesh
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Afrooz Morvaridi
- Department of Pathology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Antibiotic Resistance Prevalence in Routine Bloodstream Isolates from Children's Hospitals Varies Substantially from Adult Surveillance Data in Europe. Pediatr Infect Dis J 2015; 34:734-41. [PMID: 25607829 DOI: 10.1097/inf.0000000000000652] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surveillance of antimicrobial resistance (AMR) is central for defining appropriate strategies to deal with changing AMR levels. It is unclear whether childhood AMR patterns differ from those detected in isolates from adult patients. METHODS Resistance percentages of nonduplicate Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa bloodstream isolates from children less than 18 years of age reported to the Antibiotic Resistance and Prescribing in European Children (ARPEC) project were compared with all-age resistance percentages reported by the European Antimicrobial Resistance Surveillance Network (EARS-Net) for the same pathogen-antibiotic class combinations, period and countries. In addition, resistance percentages were compared between ARPEC isolates from children less than 1 year of age and children greater than or equal to1 year of age. RESULTS Resistance percentages for many important pathogen-antibiotic class combinations were different for ARPEC isolates compared with EARS-Net. E. coli and K. pneumoniae fluoroquinolone resistance percentages were substantially lower in ARPEC (13.4% and 17.9%) than in EARS-Net (23.0% and 30.7%), whereas the reverse was true for all pathogen-antibiotic class combinations in P. aeruginosa (for example, 27.3% aminoglycoside resistance in ARPEC, 19.3% in EARS-Net, 32.8% carbapenem resistance in ARPEC and 20.5% in EARS-Net), and for S. pneumoniae and macrolide resistance. For many Gram-negative pathogen-antibiotic class combinations, isolates from children greater than or equal to 1 year of age showed higher resistance percentages than isolates from children less than 1 year of age. CONCLUSIONS Age-stratified presentation of resistance percentage estimates by surveillance programs will allow identification of important variations in resistance patterns between different patient groups for targeted intervention.
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Le Doare K, Bielicki J, Heath PT, Sharland M. Systematic Review of Antibiotic Resistance Rates Among Gram-Negative Bacteria in Children With Sepsis in Resource-Limited Countries. J Pediatric Infect Dis Soc 2015; 4:11-20. [PMID: 26407352 DOI: 10.1093/jpids/piu014] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/16/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Gram-negative antimicrobial resistance (AMR) is of global concern, yet there are few reports from low- and low-middle-income countries, where antimicrobial choices are often limited. METHODS This study offers a systematic review of PubMed, Embase, and World Health Organization (WHO) regional databases of Gram-negative bacteremia in children in low- and low-middle-income countries reporting AMR since 2001. RESULTS Data included 30 studies comprising 71 326 children, of whom 7056 had positive blood cultures, and Gram-negative organisms were isolated in 4710 (66.8%). In neonates, Klebsiella pneumoniae median resistance to ampicillin was 94% and cephalosporins 84% in Asia; 100% and 50% in Africa. Large regional variations in resistance rates to commonly prescribed antibiotics for Salmonella spp. were identified. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was present in 30% (interquartile range [IQR], 0-59.6) in Asia and 75% (IQR, 30-85.4) in Africa. CONCLUSIONS There is a need for an international pediatric antimicrobial resistance surveillance system that collects local epidemiological data to improve the evidence base for the WHO guidance for childhood Gram-negative bacteremia.
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Affiliation(s)
- Kirsty Le Doare
- Wellcome Centre for Global Health Research, Imperial College, London Paediatric Infectious Diseases Research Group, St George's University of London, UK
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, St George's University of London, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George's University of London, UK
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Current management of late onset neonatal bacterial sepsis in five European countries. Eur J Pediatr 2014; 173:997-1004. [PMID: 24522326 DOI: 10.1007/s00431-014-2279-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/22/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Late onset neonatal sepsis (LOS) has a high mortality and the optimal management is poorly defined. We aimed to evaluate new expert panel-derived criteria to define LOS and characterize the current management and antibiotic susceptibility of LOS-causing organisms in Europe. A prospective observational study enrolled infants aged 4 to 90 days in five European countries. Clinical and laboratory findings as well as empiric treatment were recorded and patients were followed until the end of antibiotic therapy. Failure was defined as a change of primary antibiotic, no resolution of clinical signs, appearance of new signs/pathogens or death. Antibiotic therapy was considered appropriate if the organism was susceptible to at least one empiric antibiotic. 113 infants (median age 14 days, 62 % ≤1500 g) were recruited; 61 % were culture proven cases (28 CoNS, 24 Enterobacteriaceae, 11 other Gram-positives and 6 Gram-negative non-fermentative organisms). The predictive value of the expert-panel criteria to identify patients with a culture proven LOS was 61 % (95 % CI 52 % to 70 %). Around one third of Enterobacteriaceae were resistant to ampicillin + or cefotaxime + gentamicin but only 10 % to meropenem. Empiric treatment contained a total of 43 different antibiotic regimens. All-cause mortality was 8 % with an additional 45 % classified as failure of empiric therapy, mainly due to change of primary antibiotics (42/60). CONCLUSIONS The expert panel-derived diagnostic criteria performed well identifying a high rate of culture proven sepsis. Current management of LOS in Europe is extremely variable suggesting an urgent need of evidence-based guidelines.
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Ares MÁ, Alcántar-Curiel MD, Jiménez-Galicia C, Rios-Sarabia N, Pacheco S, De la Cruz MÁ. Antibiotic resistance of gram-negative bacilli isolated from pediatric patients with nosocomial bloodstream infections in a Mexican tertiary care hospital. Chemotherapy 2014; 59:361-8. [PMID: 24821320 DOI: 10.1159/000362085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gram-negative bacilli are the most common bacteria causing nosocomial bloodstream infections (NBSIs) in Latin American countries. METHODS The antibiotic resistance profiles of Gram-negative bacilli isolated from blood cultures in pediatric patients with NBSIs over a 3-year period in a tertiary care pediatric hospital in Mexico City were determined using the VITEK-2 system. Sixteen antibiotics were tested to ascertain the resistance rate and the minimum inhibitory concentration using the Clinical Laboratory Standards Institute (CLSI) broth micro-dilution method as a reference. RESULTS A total of 931 isolates were recovered from 847 clinically significant episodes of NBSI. Of these, 477 (51.2%) were caused by Gram-negative bacilli. The most common Gram-negative bacilli found were Klebsiella pneumoniae (30.4%), Escherichia coli (18.9%), Enterobacter cloacae (15.1%), Pseudomonas aeruginosa (9.9%), and Acinetobacter baumannii (4.6%). More than 45 and 60% of the K. pneumoniae and E. coli isolates, respectively, were resistant to cephalosporins, and 64% of the E. coli isolates were resistant to fluoroquinolones. A. baumannii exhibited low rates of resistance to antibiotics tested. In the E. cloacae and P. aeruginosa isolates, no rates of resistance higher than 38% were observed. CONCLUSIONS In this study, we found that the proportion of NBSIs due to antibiotic-resistant organisms is increasing in a tertiary care pediatric hospital of Mexico.
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Affiliation(s)
- Miguel Ángel Ares
- Laboratorio de Microbiología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Pereira CAP, Marra AR, Camargo LFA, Pignatari ACC, Sukiennik T, Behar PRP, Medeiros EAS, Ribeiro J, Girão E, Correa L, Guerra C, Carneiro I, Brites C, Reis M, de Souza MA, Tranchesi R, Barata CU, Edmond MB. Nosocomial bloodstream infections in Brazilian pediatric patients: microbiology, epidemiology, and clinical features. PLoS One 2013; 8:e68144. [PMID: 23861860 PMCID: PMC3701648 DOI: 10.1371/journal.pone.0068144] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/26/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. METHODS We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). RESULTS In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. CONCLUSIONS In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.
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Affiliation(s)
| | - Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Luis Fernando Aranha Camargo
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | | | | | | | - Luci Correa
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Hospital do Rim e Hipertensão, São Paulo, Brazil
| | | | | | | | - Marise Reis
- Hospital do Coração, Natal, Brazil
- Hospital da UNIMED, Natal, Brazil
| | | | | | - Cristina U. Barata
- Universidade Federal do Triangulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Michael B. Edmond
- Virginia Commonwealth University, Richmond, Virginia, United States of America
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