The risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

QIN Fang ^1,2,3,4 , HUANG Liang ^1,2,3,4 , ZHANG Chuan ^2,3,4 , SHI Jing ⁵ , ZENG Linan ^2,3,4 , LI Hailong ^2,3,4 ,  ZHANG Lingli ^2,3,4 ,  WANG Ling ¹

1. West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
4. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610041, P.R.China;
5. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding?author：

ZHANG Lingli, Email: zhanglingli@scu.edu.cn; WANG Ling, Email: rebeccawang312@gmail.com

Keywords：

Carbapenem-resistant enterobacteriaceae; Colonization; Infection; Neonates; Systematic review; Case-control study

DOI：

10.7507/1672-2531.202009061

Video：

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Objectives To systematically review the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort or case-control studies on the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by RevMan5.3 software.Results A total of 9 case-control studies involving 759 patients were included. The results of meta-analysis showed that, maternal factors like placental abruption (OR=6.25, 95%CI 1.47 to 26.61, P=0.01), premature rupture of fetal membranes of parturient (OR=5.62, 95%CI 2.63 to 12.00, P<0.000 01), pregnancy-induced hypertension (OR=2.04, 95%CI 1.49 to 2.80, P<0.000 01), carbapenem antibiotics used in mothers (OR=1.77, 95%CI 1.10 to 2.81, P=0.017), neonatal factors like premature delivery (OR=1.96, 95%CI 1.06 to 3.61, P=0.03), mechanical ventilation (OR=2.14, 95%CI 1.01 to 4.55, P=0.05), surgical procedure (OR=14.17, 95%CI 2.46 to 81.70, P=0.003), umbilical vein catheter (OR=1.93, 95%CI 1.20 to 3.11, P=0.007), peripherally inserted central catheter (OR=4.30, 95%CI 1.86 to 9.93, P=0.000 6), nasogastric feeding (OR=4.37, 95%CI 1.44 to 13.29, P=0.009), use of carbapenems (OR=3.04, 95%CI 1.91 to 4.84, P<0.000 01), and admission to NICU (OR=2.78, 95%CI 1.79 to 4.33, P<0.000 01) were the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Breastfeeding (OR=0.30, 95%CI 0.13 to 0.70, P=0.005) was the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.Conclusions The current evidence shows that maternal factors like placental abruption, premature rupture of fetal membranes, pregnancy-induced hypertension, carbapenem antibiotics used in mothers, and neonatal factors like premature delivery, mechanical ventilation, surgical procedure, umbilical vein catheter, peripherally inserted central catheter, nasogastric feeding, use of carbapenems, and admission to NICU are the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates; while breastfeeding is the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.

Citation： QIN Fang, HUANG Liang, ZHANG Chuan, SHI Jing, ZENG Linan, LI Hailong, ZHANG Lingli, WANG Ling. The risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates: a systematic review. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1390-1396. doi: 10.7507/1672-2531.202009061 Copy

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7.	劉偉, 賴曉全, 譚昆, 等. 新生兒肺炎克雷伯菌醫院感染預后相關因素分析. 中華醫院感染學雜志, 2019, 29(13): 2024-2028.
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14.	王芳, 魯巧云, 胡鳳琪, 等. 醫院感染嗜麥芽窄食單胞菌危險因素的 Meta 分析. 中國感染控制雜志, 2020, 19(2): 131-136.
15.	劉媛, 王婉霞. 新生兒 CRKP 院內感染性肺炎的危險因素分析. 海南醫學, 2020, 31(1): 62-65.
16.	李書津, 徐發林, 李文麗, 等. 早產兒耐碳青霉烯類肺炎克雷伯菌敗血癥 23 例臨床分析. 中華新生兒科雜志(中英文), 2019, 34(5): 329-333.
17.	李秋陽, 金鳳玲. 兒科重癥監護室耐碳青霉烯類腸桿菌科細菌的分布特征及危險因素分析. 國際檢驗醫學雜志, 2019, 40(16): 1980-1984, 1988.
18.	譚莉, 凃敏, 彭威軍, 等. 新生兒耐碳青霉烯類肺炎克雷伯菌醫院感染相關因素分析. 中華醫院感染學雜志, 2018, 28(18): 2811-2814.
19.	曹陽, 毛靜秋, 魏殿軍, 等. 新生兒碳青霉烯類耐藥肺炎克雷伯菌的耐藥性及其定植的危險因素分析. 中華臨床感染病雜志, 2015, (5): 407-412.
20.	馬明圣, 王丹華, 孫秀靜, 等. 新生兒發生產肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌定植的危險因素分析. 中國當代兒科雜志, 2014, (10): 970-974.
21.	Chabah M, Chemsi M, Zerouali K, et al. Healthcare-associated infections due to carbapenemase-producing Enterobacteriaceae: Bacteriological profile and risk factors. Med Mal Infect, 2016, 46(3): 157-162.
22.	Giuffrè M, Bonura C, Geraci DM, et al. Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy. J Hosp Infect, 2013, 85(3): 233-236.
23.	喬甫, 宗志勇. 世界衛生組織《醫療機構耐碳青霉烯的腸桿菌科細菌、銅綠假單胞菌和鮑曼不動桿菌防控指南》介紹. 華西醫學, 2018, 33(3): 259-263.
24.	王強, 李幼平, 張伯禮, 等. 指南臨床適用性評價的問題與需求. 中國循證醫學雜志, 2020, 20(3): 249-251.
25.	Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol, 2017, 186(12): 1319-1328.
26.	Yahya L, Alhubaishi A. Premature rupture of membrane and neonatal infection. Open J Obstet Gynecol, 2019, 9: 1388-1391.
27.	Mouzinho A, Rosenfeld CR, Sanchez PJ, et al. Effect of maternal hypertension on neonatal neutropenia and risk of nosocomial infection. Pediatrics, 1992, 90(3): 430-435.
28.	Collins A, Weitkamp JH, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed, 2018, 103(4): F391-F394.
29.	劉銀梅, 史慶豐, 吳曉松, 等. 耐碳青霉烯類肺炎克雷伯菌血流感染危險因素的 Meta 分析. 中國消毒學雜志, 2020, 37(7): 513-517, 520.
30.	唐麗玲, 張培金, 錢麗華, 等. 我國碳青霉烯類耐藥肺炎克雷伯菌感染危險因素 Meta 分析. 中國消毒學雜志, 2019, 36(3): 199-202, 205.

1. CDC. Facility guidance for control of carbapenem-resistant enterobacteriaceae (CRE), 2020-06-20. Available at: https://www.cdc.gov/hai/pdfs/cre/cre-guidance-508.pdf.
2. Nordmann P, Naas T, Poirel L. Global spread of Carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis, 2011, 17(10): 1791-1798.
3. Falagas ME, Tansarli GS, Karageorgopoulos DE, et al. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis, 2014, 20(7): 1170-1175.
4. WHO. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics, 2020-06-20. Available at: https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/.
5. 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.
6. 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.
7. 劉偉, 賴曉全, 譚昆, 等. 新生兒肺炎克雷伯菌醫院感染預后相關因素分析. 中華醫院感染學雜志, 2019, 29(13): 2024-2028.
8. 姚恩鳳, 孫玄, 姜麗, 等. 新生兒耐碳青霉烯類肺炎克雷伯菌敗血癥臨床分析. 中華新生兒科雜志(中英文), 2019, 34(2): 119-124.
9. van Loon K, Voor In 't Holt AF, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant enterobacteriaceae. Antimicrob Agents Chemother, 2017, 62(1): e01730-1717.
10. WHO. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities, 2020-06-20. Available at: https://www.who.int/infection-prevention/publications/guidelines-cre/en/.
11. Magiorakos AP, Burns K, Rodríguez Ba?o J, et al. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from ECDC. Antimicrob Resist Infect Control, 2017, 6: 113.
12. 中華人民共和國國家衛生. 關于印發碳青霉烯類抗菌藥物臨床應用專家共識等 3 個技術文件的通知, 2020-06-20. Available at: http://www.nhc.gov.cn/yzygj/s7659/201809/95f65ca473b44746b24590e94468b8ff.shtml.
13. Wells G, Shea B, O'connell DL, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Appl Eng Agric, 2014, 18(6): 727-734.
14. 王芳, 魯巧云, 胡鳳琪, 等. 醫院感染嗜麥芽窄食單胞菌危險因素的 Meta 分析. 中國感染控制雜志, 2020, 19(2): 131-136.
15. 劉媛, 王婉霞. 新生兒 CRKP 院內感染性肺炎的危險因素分析. 海南醫學, 2020, 31(1): 62-65.
16. 李書津, 徐發林, 李文麗, 等. 早產兒耐碳青霉烯類肺炎克雷伯菌敗血癥 23 例臨床分析. 中華新生兒科雜志(中英文), 2019, 34(5): 329-333.
17. 李秋陽, 金鳳玲. 兒科重癥監護室耐碳青霉烯類腸桿菌科細菌的分布特征及危險因素分析. 國際檢驗醫學雜志, 2019, 40(16): 1980-1984, 1988.
18. 譚莉, 凃敏, 彭威軍, 等. 新生兒耐碳青霉烯類肺炎克雷伯菌醫院感染相關因素分析. 中華醫院感染學雜志, 2018, 28(18): 2811-2814.
19. 曹陽, 毛靜秋, 魏殿軍, 等. 新生兒碳青霉烯類耐藥肺炎克雷伯菌的耐藥性及其定植的危險因素分析. 中華臨床感染病雜志, 2015, (5): 407-412.
20. 馬明圣, 王丹華, 孫秀靜, 等. 新生兒發生產肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌定植的危險因素分析. 中國當代兒科雜志, 2014, (10): 970-974.
21. Chabah M, Chemsi M, Zerouali K, et al. Healthcare-associated infections due to carbapenemase-producing Enterobacteriaceae: Bacteriological profile and risk factors. Med Mal Infect, 2016, 46(3): 157-162.
22. Giuffrè M, Bonura C, Geraci DM, et al. Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy. J Hosp Infect, 2013, 85(3): 233-236.
23. 喬甫, 宗志勇. 世界衛生組織《醫療機構耐碳青霉烯的腸桿菌科細菌、銅綠假單胞菌和鮑曼不動桿菌防控指南》介紹. 華西醫學, 2018, 33(3): 259-263.
24. 王強, 李幼平, 張伯禮, 等. 指南臨床適用性評價的問題與需求. 中國循證醫學雜志, 2020, 20(3): 249-251.
25. Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol, 2017, 186(12): 1319-1328.
26. Yahya L, Alhubaishi A. Premature rupture of membrane and neonatal infection. Open J Obstet Gynecol, 2019, 9: 1388-1391.
27. Mouzinho A, Rosenfeld CR, Sanchez PJ, et al. Effect of maternal hypertension on neonatal neutropenia and risk of nosocomial infection. Pediatrics, 1992, 90(3): 430-435.
28. Collins A, Weitkamp JH, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed, 2018, 103(4): F391-F394.
29. 劉銀梅, 史慶豐, 吳曉松, 等. 耐碳青霉烯類肺炎克雷伯菌血流感染危險因素的 Meta 分析. 中國消毒學雜志, 2020, 37(7): 513-517, 520.
30. 唐麗玲, 張培金, 錢麗華, 等. 我國碳青霉烯類耐藥肺炎克雷伯菌感染危險因素 Meta 分析. 中國消毒學雜志, 2019, 36(3): 199-202, 205.

Chinese Journal of Evidence-Based Medicine

The risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates: a systematic review

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