Distribution characteristics and drug resistance of carbapenem-resistant Enterobacteriaceae in children from 2016 to 2017

Abstract

Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae (CRE) isolated from children in China. Methods CRE strains were collected in 10 tertiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method (KB method) and automated method. The results were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) Standards published in 2017. WHONET 5.6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3 065 CRE clinical strains were isolated from children with an overall prevalence of 7.7% and among them, 13.5% were isolated in neonatal group and 5.8% in non-neonatal group. The detection rate of CRE in 2017 was higher than that in 2016 (9.7% vs 5.7%). Among the 3 065 CRE strains, there were 1 912 strains of Klebsiella pneumoniae (62.0%), 667 strains of Escherichia coli (22.0%), 206 strains of Enterobacter cloacae (7.0%), 56 strains of Klebsiella aerogenes (1.8%) and 47 strains of Serratia marcescens (1.5%). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44.8% and 19.7%, respectively. Respiratory tract (61.8%), urine (19.4%) and blood (5.7%) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79.6%-100%), especially those isolated in the neonatal group (P<0.05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19.7%) and fosfomycin (11.9%), fluoroquinolones such as levofloxacin (37.7%) and ciprofloxacin (43.3%), and tigecycline (3.8%). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug resistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken. Key words: Carbapenem-resistant Enterbacteriaceae; Drug resistance; Children