Abstract
BackgroundGram-negative bacilli are a cause of serious infections in the pediatric population. Carbapenem are the treatment of choice for infections caused by multidrug-resistant Gram-negative bacilli, but the emergence of carbapenem resistance has substantially reduced access to effective antimicrobial regimens. Children are a population vulnerable to bacterial infections and the emergence of resistance can worsen prognosis. The aim of this study is to describe the clinical and molecular characteristics of infections caused by carbapenem-resistant Gram-negative bacilli in pediatric patients from five tertiary-care hospitals in Medellín, Colombia.MethodsA cross-sectional study was conducted in five tertiary-care hospitals from June 2012 to June 2014. All pediatric patients infected by carbapenem-resistant Gram-negative bacilli were included. Clinical information for each patient was obtained from medical records. Molecular analyses included PCR for detection of blaVIM, blaIMPblaNDM,blaOXA-48 and blaKPC genes and PFGE and MLST for molecular typing.ResultsA total of 59 patients were enrolled, most of them less than 1 year old (40.7 % n = 24), with a previous history of antibiotic use (94.9 %; n = 56) and healthcare-associated infections - predominately urinary tract infections (31.0 %; n = 18). Klebsiella pneumoniae was the most frequent bacteria (47.4 %), followed by Enterobacter cloacae (40.7 %) and Pseudomonas aeruginosa (11.9 %). For K. pneumoniae, KPC was the predominant resistance mechanism (85.7 %; n = 24) and ST14 was the most common clone (39.3 % n = 11), which included strains closely related by PFGE. In contrast, E. cloacae and P. aeruginosa were prevailing non-carbapenemase-producing isolates (only KPC and VIM were detected in 1 and 3 isolates, respectively) and high genetic diversity according to PFGE and MLST was found in the majority of the cases.ConclusionsIn recent years, increasing carbapenem-resistant bacilli in children has become in a matter of great concern. It is important to conduct systemic surveillance and take measures to prevent dissemination of multidrug-resistant bacteria.
Highlights
Gram-negative bacilli are a cause of serious infections in the pediatric population
Clinical and epidemiological characteristics Of a total about 673 pediatric patients infected by K. pneumoniae, E. cloacae, P. aeruginosa and A. baumannii during the study period, 59 (8.8 %) were infected by carbapenem-resistant isolates and were included in this report; most of them male (55.9 %; n = 33) and less than 1 year old (40.7 %; n = 24)
P. aeruginosa was predominant in Hospital A (66.7 %; n = 16), while K. pneumoniae was more frequent in hospital B (39.3 % n = 11)
Summary
Gram-negative bacilli are a cause of serious infections in the pediatric population. Carbapenem are the treatment of choice for infections caused by multidrug-resistant Gram-negative bacilli, but the emergence of carbapenem resistance has substantially reduced access to effective antimicrobial regimens. The aim of this study is to describe the clinical and molecular characteristics of infections caused by carbapenem-resistant Gram-negative bacilli in pediatric patients from five tertiary-care hospitals in Medellín, Colombia. Frequent use of carbapenems has led to the emergence of resistance mechanisms, mediated primarily by enzymes called carbapenemases [3, 4]. These enzymes are found in mobile genetic elements which afford their dissemination and further limit treatment options, because they often harbor mechanisms of resistance to other antibiotics such as fluoroquinolones and aminoglycosides, necessitating the use of highly toxic antibiotics such as colistin [3, 4]. The child population in this issue is of great concern as it is a naturally vulnerable population in which the risk may vary, depending on immunological maturity, the presence of comorbidities, the presence of invasive medical devices, and even the prior use of antibiotics [6, 7]
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