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Treatment of MDR Gram(-) Infections
Prevention is Best: Multi-Drug Resistant Gram-Negative Organisms
MULTIDRUG RESISTANT BACTERIA COLONIZATIONS IN PAEDIATRIC PATIENTS WITH CANCER OR HEMATOPOIETIC STEM CELL TRANSPLANTATION IN SPAIN
Multidrug resistant bacteria (MDRB) infections are a rising concern, especially those associated with healthcare environments. The aims of this study were to describe the characteristics of MDRB colonizations in paediatric patients admitted to a Haemato-Oncology ward and to establish the risk of having a MDRB infection in a patient previously colonised.
Multicentre prospective observational study from May 2021-March 2022 in Spain. Patients < 18 years with diagnosis of cancer or hematopoietic stem cell transplantation (HSCT) admitted to Hemato-Oncology wards, were included. Rectal and nasal swabs for MDRB detection were performed at inclusion and periodically during a 90-day follow-up period. Active infection surveillance was performed during follow-up.
Data of colonization at baseline is presented.
111 patients were included: Median age was 8 (±5,5) years and 60 (54,1%) were women. Most common diagnosis were leukemia (52;46.8%), solid tumour (43;38.7%), sickle cell disease (SCD) (6;5.4%) and lymphoma (4;3.6%). 20 (18%) had undergone a HSCT.
14 (12.6%) had a MDRB colonization at baseline and 3 (2.7%) a double colonization. MDRB detected were ESBL-producing enterobacteria (7;50%), carbapenemase-producing enterobacteria (6;42.9%), MDR-Pseudomonas (2;14.3%) and MRSA (1;7.1%). No MDR-Acinetobacter or vancomycin-resistant Enterococcus were detected. The main ESBL-producing enterobacteria was E. coli (75%) and the main carbapenemase detected, VIM (66.7%). Risk factors for MDRB colonization were SCD diagnosis (p=0.03) and a previous colonization (p<0.01). Children with colonizations were more likely to have a HSCT and their father’s were more likely to have been born abroad, with no statistical significance.
Rates of ESBL and carbapenemase-producing enterobacteria colonization in a cohort of paediatric patients with cancer or SCT in Spain was high.
Children with SCD and a previous colonization have a higher risk
EPIDEMIOLOGY AND OUTCOMES OF GRAM-NEGATIVE BACTEREMIA IN A TERTIARY UNIVERSITY HOSPITAL IN MADRID, SPAIN (2018-2020).
Gram-negative bacteremia (GNB) is associated with a significant rate of morbidity and mortality in adults. Moreover, resistances to antibiotics are increasingly described in surveillance reports. However, the epidemiology and outcomes of GNB in children are not well known. We aimed to analyze GNB bacteremia in pediatric patients in a tertiary hospital over a three years period.
A retrospective, observational study of bacteremia episodes caused by Enterobacteriaceae or non-fermentative GNB in pediatric patients between January of 2018 and December 2020 in a Tertiary Hospital from Madrid, Spain, was carried out through microbiology charts and clinical records. Demography, comorbidities, risk factors and infection characteristics were recorded, and bacterial strain and antibiotic resistance were registered. Three primary endpoints were defined: mortality, bacteremia persistence and recurrence. A statistical analysis was applied to assess differences in these outcomes according to the risk factors. A multivariable logistic regression analysis was used to assess the association between bacteria resistance and mortality.
One hundred eighteen cases of GNB in one hundred and seven patients were included. The characteristics of the patients are shown in Table 1. In fifty-three cases (44.9%) GNB presented resistance to at least one group of antibiotic and in nine (7.6%) were multidrug-resistant (Table 1). The incidence of resistance rates by years were stable. Indwelling urinary catheterization was a risk factor associated to mortality [OR 3.48 (1.20-10.6)] and parenteral nutrition was related to persistent bacteremia [OR 7.69 (1.1-209)]. No relation between drug resistance and mortality was observed in multivariable analysis.
GNB represented an important problem in our institution, mainly related to neonatal intensive care and heart surgery. Antibiotic resistance was common. Patients that carried invasive care devices presented higher rates of bacteremia persistence and mortality.
EPIDEMIOLOGY AND CLINICAL OUTCOMES OF GRAM-NEGATIVE BLOODSTREAM INFECTIONS IN HOSPITALISED AUSTRALIAN CHILDREN
Gram-negative bloodstream infections (GNBSI) in children are of increasing concern, being associated with significant mortality and antimicrobial resistance. There are few population-based data to describe the risk factors and clinical outcomes from GNBSI in children. We established a surveillance study of GNBSI through the Australian Paediatric Active Enhanced Disease Surveillance (PAEDS) network. Here are the findings from the first 2 years (2019-2020).
Active surveillance commenced in five Australian tertiary paediatric hospitals in January 2019. Patients aged <18 years with a pathogenic Gram-negative organism in blood culture and suspicion of systemic infection were included. Clinical features, risk factors, antimicrobial therapy and outcomes including length of hospital and intensive care unit (ICU) stay, 30-day and in-hospital mortality, and complications associated with hospitalisation were recorded.
From January 2019 to December 2020, there were 639 episodes of GNBSIs in 565 children, and 679 isolates identified. The median age was 2.9 years (IQR 0.5-7.7 years) and 59% were male. 53% were community onset and 72% occurred in children with comorbidities. Malignancy was the most common comorbidity (36%). Intravascular device was the source for 26%. Microbiology is shown in Figure 1. 13% were already in ICU at time of GNBSI onset with an additional 13% requiring ICU admission. Median duration of hospitalisation was 14 days (IQR 8-35 days). There were 42 deaths from all causes (7%) during admission, with GNBSI contributory to 60% of deaths. Nine deaths occurred within 30-days (1.4%), with no significant differences in those with/without comorbidities (1.3% vs 1.8% p-value=0.71).
GNBSI in children are associated with significant mortality and over half are healthcare associated, with a notable proportion requiring ICU admission.