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Aguilera-Alonso D, Escosa-García L, Epalza C, Bravo-Queipo-de-Llano B, Camil Olteanu F, Cendejas-Bueno E, Orellana MÁ, Cercenado E, Saavedra-Lozano J. Antibiotic resistance in bloodstream isolates from high-complexity paediatric units in Madrid, Spain: 2013-2021. J Hosp Infect 2023; 139:33-43. [PMID: 37331378 DOI: 10.1016/j.jhin.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) has become a significant challenge in high-complexity healthcare settings. AIM To evaluate the prevalence of AMR in bloodstream isolates from high-complexity paediatric units in Spain over a nine-year period. METHODS A retrospective observational multicentre study was conducted in three tertiary hospitals, analysing bloodstream isolates from patients aged <18 years admitted to the paediatric intensive care, neonatology, and oncology-haematology units between 2013 and 2021. Demographics, antimicrobial susceptibility, and resistance mechanisms were analysed in two periods (2013-2017 and 2017-2021). FINDINGS In all, 1255 isolates were included. AMR was more prevalent in older patients and those admitted to the oncology-haematology unit. Multidrug resistance was observed in 9.9% of Gram-negative bacteria (GNB); 20.0% of P. aeruginosa vs 8.6% of Entero-bacterales (P < 0.001), with an increase in Enterobacterales from 6.2% to 11.0% between the first and the second period (P = 0.021). Difficult-to-treat resistance was observed in 2.7% of GNB; 7.4% of P. aeruginosa vs 1.6% of Enterobacterales (P < 0.001), with an increasing trend in Enterobacterales from 0.8% to 2.5% (P = 0.076). Carbapenem resistance among Enterobacterales increased from 3.5% to 7.2% (P = 0.029), with 3.3% producing carbapenemases (67.9% VIM). Meticillin resistance was observed in 11.0% of S. aureus and vancomycin resistance in 1.4% of Enterococcus spp., with both rates remaining stable throughout the study period. CONCLUSION This study reveals a high prevalence of AMR in high-complexity paediatric units. Enterobacterales showed a concerning increasing trend in resistant strains, with higher rates among older patients and those admitted to oncology-haematology units.
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Affiliation(s)
- D Aguilera-Alonso
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - L Escosa-García
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain; Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - C Epalza
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - B Bravo-Queipo-de-Llano
- Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain
| | - F Camil Olteanu
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Paediatrics, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - E Cendejas-Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Microbiology, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - M Á Orellana
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - E Cercenado
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - J Saavedra-Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
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