Frequency of Bacteremia due to Carbapenemase-producing Enterobacteriaceae in Pediatric Hematology-Oncology Can Be Reduced by Measures of Hospital Infection Control

Abstract

Objectives: The spread of carbapenemase-producing Enterobacteriaceae (CPE) is an emerging problem in children undergoing cancer-directed chemotherapy. A previous Italian survey reported a threefold increase in CPE colonization rate and a fourfold increase of CPE bloodstream infections in a 2 year-observation time interval. Methods: To assess the efficacy of the measures put in place to control this emergency, a second survey was performed in the years 2016-2017 and the results were compared. Results: The overall rate of colonization was comparable between the two study periods: 0.50% (2016-2017) vs. 0.48% (2012-2013). MDR/CPE bacteremia was now reported in 13 children from six centers. The rate of MDR/CPE bacteremia was 0.12 for 1,000 days of hospitalization (95% CI, 0.07-0.21) and compared favorably with that observed in the previous survey (0.42 for 1,000 days of hospitalization; 95% CI, 0.31-0.57; p<0.0001). The strains responsible for bacteremia were Klebsiella pneumonia in 9/13 children, Escherichia coli in 2/13, Citrobacter spp. and Stenotrophomonas maltophilia in one case each. The antibiotic susceptibility was available for 10 MDR/CPE strains. Conclusion: The number of patients colonized by CPE remained stable over the years, while the number of bloodstream infections decreased, as well as the resulting mortality. We conclude that children undergoing chemotherapy are at risk for CPE colonization/infection but the awareness of their colonization status may allow reducing CPE morbidity and mortality. J Microbiol Infect Dis 2021; 11(1):27-31.