Active surveillance and appropriate patient placement in contact isolation dramatically decreased carbapenem-resistant Enterobacterales infection and colonization in paediatric patients in China

Yin, Liu; He, Leiyan; Jin, Miao; Yang, Weiqing; Wang, Xiaohua; Ma, Jing; Wu, Nana; Cao, Yun; Wang, Laishuan; Li, Guoping; Li, Liling; Lu, Chunmei; Hu, Jing; Zhang, Lei; Zhao, Bing; Zhai, Xiaowen

doi:10.1016/j.jhin.2020.03.031

Cited by 23 publications

(30 citation statements)

References 33 publications

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“…ST437 belonged to clonal complex 11 (CC11), which was together with its single-locus variants ST11 and ST258 [ 24 ]. The high-risk multidrug-resistant CC11 is widespread worldwide, and cases with the CC11 strain faced more severe forms of drug resistance and treatment challenges than other clonal complex [ 8 ], especially KPC-producing and NDM-producing CC11. Among CC11, ST258 CRKP predominated in North America and Europe [ 25 ]; furthermore, ST11 was the primary CRKP clone in eastern Asia, especially in China [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clonal complex 11 (CC11) denotes the STs differed from ST11 by one housekeeper gene, including ST11, ST258, ST340, ST437, ST757, ST855, and others. CC11 is an epidemic K. pneumoniae clonal complex [ 1 ], and cases with the CC11 strain faced more severe forms of drug resistance and treatment challenges than other clonal complexes [ 8 ]. KPC-producing [ 1 ] and NDM-producing [ 9 ] CC11 have been reported in China, and no one reported OXA-48-type-producing CC11 clone in China although a clonal dissemination of OXA-48-producing ST147 and ST383 [ 4 ] as well as two clonal disseminations of OXA-232-producing ST15 have been reported in China [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

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The Characterization of OXA-232 Carbapenemase-Producing ST437 Klebsiella pneumoniae in China

Weng

Shi

Wang

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) was epidemic around the world and become a global threat to public health. The most important carbapenem-resistant mechanism is producing carbapenemases, especially Klebsiella pneumoniae carbapenemase (KPC), which is prevalent in the international clonal complex CC11. The high-risk multidrug-resistant CC11 is widespread worldwide, and KPC-producing and (New Delhi metallo) NDM-producing strains had been reported in this clonal complex before; moreover, cases with the CC11 strain faced more severe forms of drug resistance and treatment challenges than other clonal complexes. In this study, we identified an OXA-232-producing ST437 Klebsiella pneumoniae isolate in China, which belonged to CC11. The isolate was resistant to β-lactams, aminoglycosides, and fluoroquinolones but susceptible to fosfomycin, tigecycline, and colistin. The blaOXA-232 gene was located on a 6141 bp ColKP3-type nonconjugative plasmid, and the plasmid was transformed by chemical transformation successfully. This is the first report of OXA-232-producing ST437 K. pneumoniae in China, a new clone of high-risk multidrug-resistant CC11.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Characterization of OXA-232 Carbapenemase-Producing ST437 Klebsiella pneumoniae in China

Weng

Shi

Wang

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…52 CRE colonization is a prerequisite for development of CRE infection. According to a recent study conducted in Children's Hospital of Fudan University, 53 active CRE colonization surveillance and CRE positive patient propriety placement may decrease the CRE infection risk.…”

Section: Discussionmentioning

confidence: 99%

<p>Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> from Inpatient Children in a Pediatric Hospital of Shanghai</p>

Pan

Sun

et al. 2020

IDR

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“…This was a single-center, cross-sectional, retrospective study performed at the NICU of the Children's Hospital of Fudan University, a tertiary-care teaching hospital of 800 beds. Over the years, the unit with the highest CRE nosocomial infection incidence was the NICU (1.3%) [ 5 ]. We evaluated all consecutive patients admitted to the NICU, and CRE intestinal and upper respiratory tract colonization screening and CRE infection surveillance were performed from January 2017 to December 2018, as previously described [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study we found that, among the children in our hospital, those in the neonatal intensive care unit (NICU) had the highest proportion of CRE nosocomial infections, and neonatal and non-neonatal patients showed different CRE molecular characteristics [ 5 ]. Therefore, identifying the risk for CRE infection in NICU patients and classifying genotypes are priorities in this vulnerable population.…”

Section: Introductionmentioning

confidence: 99%

Carbapenem-resistant Enterobacterales colonization and subsequent infection in a neonatal intensive care unit in Shanghai, China

Yin

Jin

et al. 2021

Infection Prevention in Practice

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SUMMARY Background Colonization has been reported to play an important role in carbapenem-resistant Enterobacterales (CRE) infection; however, the extent to which carriers develop clinical CRE infection and related risk factors in neonatal intensive care unit (NICU) patients is unclear. Aim To investigate the frequency of CRE colonization and its contribution to infections in NICU patients. Methods CRE colonization screening and CRE infection surveillance were performed in the NICU in 2017 and 2018. Findings Among 1230 unique NICU patients who were screened for CRE colonization, 144 patients tested positive (11.7%, 144/1230), with 9.2% (110/1197) in the intestinal tract, which was higher than that in the upper respiratory tract (6.6%, 62/945) ( P =0.026). Gestational age, low birth weight and prolonged hospitalization were risk factors for CRE colonization (all P <0.001). Diversilab homology monitoring found an overall 17.4% (25/144) risk of infection among patients colonized with CRE. For carbapenem-resistant Klebsiella pneumoniae (CR-KP) and carbapenem-resistant Escherichia coli (CR-ECO), the risks were 19.1% (21/110) and 13.8% (4/29), respectively. The independent risk factors for CR-KP clinical infection among CR-KP carriers were receiving mechanical ventilation (odds ratio (OR), 10.177; 95% confidence interval (CI), 2.667–38.830; P =0.013), a high level of neonatal nutritional risk assessment (OR, 0.251; 95% CI, 0.072–0.881; P =0.031) and a high neonatal acute physiology II (SNAP-II) score (OR, 0.256; 95% CI, 0.882–1.034; P =0.025). Conclusions The colonization of CRE may increase the incidence of corresponding CRE infection in NICU patients. Receiving mechanical ventilation, malnutrition and critical conditions with high SNAP-II scores were independent risk factors for subsequent CR-KP clinical infection.

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Active surveillance and appropriate patient placement in contact isolation dramatically decreased carbapenem-resistant Enterobacterales infection and colonization in paediatric patients in China

Cited by 23 publications

References 33 publications

The Characterization of OXA-232 Carbapenemase-Producing ST437 Klebsiella pneumoniae in China

The Characterization of OXA-232 Carbapenemase-Producing ST437 Klebsiella pneumoniae in China

<p>Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> from Inpatient Children in a Pediatric Hospital of Shanghai</p>

Carbapenem-resistant Enterobacterales colonization and subsequent infection in a neonatal intensive care unit in Shanghai, China

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