Background Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). Objectives To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. Methods A retrospective observational single-centre study (December 2005–August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. Results Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P < 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. Conclusions CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.
Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem in pediatric population worldwide with high mortality rates (18.5-52%) in bloodstream infection (BSI). Objectives: The aim of this study is to evaluate predictors of 30-day mortality in CRE BSI in a pediatric cohort. Methods: Retrospective observational single-center study (December 2005 - August 2018) was conducted. CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2 and MicroScan panel NBC44) according to current EUCAST breakpoints were performed. PCR OXVIKP was used to confirm carbapenemases genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteremia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day-mortality was performed. Results: Thirty-eight cases were included, 76.3% hospital-acquired infections and 23.7% related to healthcare. All patients had underlying comorbidity and 52.6% had received a transplant. VIM-carbapenemase was the predominant mechanism (92%). Previous CRE colonization or infection rate was 52.6%. Gut (26%) and vascular catheter (21%) were the predominant sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30-day mortality was 10.5%. Conditions associated with an increment in 30-day mortality were intensive care admission and inadequate empiric therapy (p<0.05). Combination antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. Conclusions: CRE BSI mortality rate is high. The most important factor related to 30-day survival in our CRE BSI cohort in children was success in empiric treatment with at least one active antibiotic.
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