A multicenter investigation of two types of carbapenem-resistant Enterobacteriaceae in pediatric patients in Jiangxi Province for three consecutive years_West China Medical Journal

Authors：

CHEN Xiuwen ¹ ,  XIE Chengfeng ¹ , ZHANG Xinping ¹ , ZHOU Yan ² , ZHOU Zhiqiu ¹ , WAN Xiaohua ¹ , LI Sisi ¹ , FU Rui ¹

1. Infection Control and Public Health Department, Jiangxi Provincial Children’s Hospital, Nanchang, Jiangxi 330006, P. R. China;
2. Clinical Laboratory, Jiangxi Provincial Children’s Hospital, Nanchang, Jiangxi 330006, P. R. China;

Corresponding?author：

XIE Chengfeng, Email: XCF815699165@163.com

Keywords：

Pediatric patient; Carbapenem-resistant Enterobacteriaceae; Carbapenem-resistant Klebsiella pneumoniae; Carbapenem-resistant Escherichia coli; Investigation

DOI：

10.7507/1002-0179.202102066

Video：

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Objective To evaluate the burden of carbapenem-resistant Klebsiella pneumoniae (CRKPN) and carbapenem-resistant Escherichia coli (CRECO), two types of carbapenem-resistant Enterobacteriaceae (CRE), in pediatric patients in Jiangxi Province.Methods A retrospective investigation was carried out for the distribution of CRKPN/CRECO in pediatric (neonatal group and non-neonatal group) and adult patients in 30 hospitals in Jiangxi Province from January 2016 to December 2018, and the changing trends and detection situations of different patients and types of hospitals were compared and analyzed.Results From 2016 to 2018, the annual resistance rates of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients were 5.89%, 4.03%, and 4.24%, respectively, showed a downward trend (χ²_trend=5.568, P=0.018). The resistance rate of Klebsiellae pneumoniae and Escherichia coli to carbapenem in neonatal group was higher than that in non-neonatal group (8.44% vs. 3.40%; χ²=63.155, P<0.001) and adult group (8.44% vs. 3.45%; χ²=97.633, P<0.001). In pediatric patients, the 3-year carbapenem resistance rate of Klebsiella pneumoniae was higher than that of Escherichia coli (9.10% vs. 2.48%; χ²=128.177, P<0.001). In non-neonatal pediatric patients, the 3-year resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in maternity and children hospitals was higher than that in general hospitals (4.35% vs. 1.36%; χ²=25.930, P<0.001). CRKPN/CRECO detected in pediatrics were mainly isolated from sputum (31.64%), blood (24.36%), urine (13.82%), and pus (8.36%).Conclusion Although the overall resistance rate of Klebsiella pneumoniae and Escherichia coli to carbapenem in pediatric patients showed a downward trend, that in neonatal patients was still high, and the monitoring and prevention and control measures of CRE should be strengthened in neonatal patients.

Citation： CHEN Xiuwen, XIE Chengfeng, ZHANG Xinping, ZHOU Yan, ZHOU Zhiqiu, WAN Xiaohua, LI Sisi, FU Rui. A multicenter investigation of two types of carbapenem-resistant Enterobacteriaceae in pediatric patients in Jiangxi Province for three consecutive years. West China Medical Journal, 2021, 36(3): 322-327. doi: 10.7507/1002-0179.202102066 Copy

1.	胡付品, 郭燕, 朱德妹, 等. 2018年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2020, 20(1): 1-10.
2.	鄭少微, 李萍, 張正良, 等. 2005-2017年中國CHINET常見革蘭陰性菌對碳青霉烯類抗生素耐藥的監測結果. 臨床急診雜志, 2019, 20(1): 40-44.
3.	劉衛平, 海云婷, 楊麗芳, 等. 某三級綜合醫院耐碳青霉烯腸桿菌科細菌流行特征及耐藥性分析. 中華醫院感染學雜志, 2020, 30(19): 2943-2948.
4.	謝偉, 景春梅. 2010-2015年重慶市某三甲兒童醫院新生兒感染細菌的變遷及耐藥性分析. 中國感染與化療雜志, 2017, 17(4): 428-432.
5.	祝俊英, 王春, 孫燕, 等. 兒科患者中分離的碳青霉烯類耐藥肺炎克雷伯菌分子流行病學分析及耐藥機制研究. 中國感染與化療雜志, 2016, 16(05): 578-582.
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7.	全國細菌耐藥監測網. 2014至2017年中國兒童及新生兒患者細菌耐藥監測研究. 中華醫學雜志, 2018, 98(40): 3279-3287.
8.	Rahal JJ. The role of carbapenems in initial therapy for serious Gram-negative infections. Crit Care, 2008, 12(Suppl 4): S5.
9.	Cassini A, H?gberg LD, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis, 2019, 19(1): 56-66.
10.	徐英春, 肖永紅, 卓超, 等. 中國碳青霉烯類耐藥腸桿菌科細菌的流行病學和防控策略. 中國執業藥師, 2013, 10(4): 3-8.
11.	Han R, Shi Q, Wu S, et al. Dissemination of carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) among carbapenem-resistant enterobacteriaceae isolated from adult and children patients in China. Front Cell Infect Microbiol, 2020, 10: 314.
12.	Montagnani C, Prato M, Scolfaro C, et al. Carbapenem-resistant Enterobacteriaceae infections in children: an Italian retrospective multicenter study. Pediatr Infect Dis J, 2016, 35(8): 862-868.
13.	Han JH, Goldstein EJ, Wise J, et al. Epidemiology of carbapenem-resistant Klebsiella pneumoniae in a network of long-term acute care hospitals. Clin Infect Dis, 2017, 64(7): 839-844.
14.	Haller S, Eller C, Hermes J, et al. What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing. BMJ Open, 2015, 5(5): e007397.
15.	胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
16.	Zhu J, Sun L, Ding B, et al. Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates. Eur J Clin Microbiol Infect Dis, 2016, 35(4): 611-618.
17.	李麗娟, 趙丹洋, 黃雪敏, 等. 全球新生兒醫院感染暴發事件數據分析. 中華醫院感染學雜志, 2020, 30(18): 2859-2863.
18.	張琴, 許健, 宋培培. 兒科患者檢出耐碳青霉烯類抗菌藥物腸桿菌科細菌分布特征及耐藥性分析. 中國抗生素雜志, 2020, 45(12): 1273-1278.
19.	邊程鵬, 張月, 莊曉玲, 等. 新生兒肺炎克雷伯菌肺炎臨床及耐藥性分析. 熱帶醫學雜志, 2020, 20(7): 959-962.
20.	姚佳峰, 李楠, 姜錦. 單中心血液腫瘤患兒合并感染病原菌分布及耐藥性病例系列報告. 中國循證兒科雜志, 2019, 14(2): 112-117.
21.	付盼, 王傳清, 俞蕙, 等. 中國兒童細菌耐藥監測組2017年兒童細菌感染及耐藥監測. 中國循證兒科雜志, 2018, 13(6): 406-411.
22.	周靜芳, 凌勇, 劉偉江, 等. 耐碳青霉烯類腸桿菌科細菌的感染特征和危險因素分析. 中華醫院感染學雜志, 2017, 27(1): 16-19.
23.	Ara-Montojo MF, Escosa-García L, Alguacil-Guillén M, et al. Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children. J Antimicrob Chemother, 2021, 76(1): 220-225.
24.	Nabarro LB, Shankar C, Pragasam AK, et al. Clinical and bacterial risk factors for mortality in children with carbapenem-resistant Enterobacteriaceae bloodstream infections in India. Pediatr Infect Dis J, 2017, 36(6): e161-e166.

1. 胡付品, 郭燕, 朱德妹, 等. 2018年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2020, 20(1): 1-10.
2. 鄭少微, 李萍, 張正良, 等. 2005-2017年中國CHINET常見革蘭陰性菌對碳青霉烯類抗生素耐藥的監測結果. 臨床急診雜志, 2019, 20(1): 40-44.
3. 劉衛平, 海云婷, 楊麗芳, 等. 某三級綜合醫院耐碳青霉烯腸桿菌科細菌流行特征及耐藥性分析. 中華醫院感染學雜志, 2020, 30(19): 2943-2948.
4. 謝偉, 景春梅. 2010-2015年重慶市某三甲兒童醫院新生兒感染細菌的變遷及耐藥性分析. 中國感染與化療雜志, 2017, 17(4): 428-432.
5. 祝俊英, 王春, 孫燕, 等. 兒科患者中分離的碳青霉烯類耐藥肺炎克雷伯菌分子流行病學分析及耐藥機制研究. 中國感染與化療雜志, 2016, 16(05): 578-582.
6. Logan LK, Renschler JP, Gandra S, et al. Carbapenem-resistant enterobacteriaceae in children, United States, 1999-2012. Emerg Infect Dis, 2015, 21(11): 2014-2021.
7. 全國細菌耐藥監測網. 2014至2017年中國兒童及新生兒患者細菌耐藥監測研究. 中華醫學雜志, 2018, 98(40): 3279-3287.
8. Rahal JJ. The role of carbapenems in initial therapy for serious Gram-negative infections. Crit Care, 2008, 12(Suppl 4): S5.
9. Cassini A, H?gberg LD, Plachouras D, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis, 2019, 19(1): 56-66.
10. 徐英春, 肖永紅, 卓超, 等. 中國碳青霉烯類耐藥腸桿菌科細菌的流行病學和防控策略. 中國執業藥師, 2013, 10(4): 3-8.
11. Han R, Shi Q, Wu S, et al. Dissemination of carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) among carbapenem-resistant enterobacteriaceae isolated from adult and children patients in China. Front Cell Infect Microbiol, 2020, 10: 314.
12. Montagnani C, Prato M, Scolfaro C, et al. Carbapenem-resistant Enterobacteriaceae infections in children: an Italian retrospective multicenter study. Pediatr Infect Dis J, 2016, 35(8): 862-868.
13. Han JH, Goldstein EJ, Wise J, et al. Epidemiology of carbapenem-resistant Klebsiella pneumoniae in a network of long-term acute care hospitals. Clin Infect Dis, 2017, 64(7): 839-844.
14. Haller S, Eller C, Hermes J, et al. What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing. BMJ Open, 2015, 5(5): e007397.
15. 胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
16. Zhu J, Sun L, Ding B, et al. Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates. Eur J Clin Microbiol Infect Dis, 2016, 35(4): 611-618.
17. 李麗娟, 趙丹洋, 黃雪敏, 等. 全球新生兒醫院感染暴發事件數據分析. 中華醫院感染學雜志, 2020, 30(18): 2859-2863.
18. 張琴, 許健, 宋培培. 兒科患者檢出耐碳青霉烯類抗菌藥物腸桿菌科細菌分布特征及耐藥性分析. 中國抗生素雜志, 2020, 45(12): 1273-1278.
19. 邊程鵬, 張月, 莊曉玲, 等. 新生兒肺炎克雷伯菌肺炎臨床及耐藥性分析. 熱帶醫學雜志, 2020, 20(7): 959-962.
20. 姚佳峰, 李楠, 姜錦. 單中心血液腫瘤患兒合并感染病原菌分布及耐藥性病例系列報告. 中國循證兒科雜志, 2019, 14(2): 112-117.
21. 付盼, 王傳清, 俞蕙, 等. 中國兒童細菌耐藥監測組2017年兒童細菌感染及耐藥監測. 中國循證兒科雜志, 2018, 13(6): 406-411.
22. 周靜芳, 凌勇, 劉偉江, 等. 耐碳青霉烯類腸桿菌科細菌的感染特征和危險因素分析. 中華醫院感染學雜志, 2017, 27(1): 16-19.
23. Ara-Montojo MF, Escosa-García L, Alguacil-Guillén M, et al. Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children. J Antimicrob Chemother, 2021, 76(1): 220-225.
24. Nabarro LB, Shankar C, Pragasam AK, et al. Clinical and bacterial risk factors for mortality in children with carbapenem-resistant Enterobacteriaceae bloodstream infections in India. Pediatr Infect Dis J, 2017, 36(6): e161-e166.

West China Medical Journal

A multicenter investigation of two types of carbapenem-resistant Enterobacteriaceae in pediatric patients in Jiangxi Province for three consecutive years

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