Factors behind the prevalence of carbapenem-resistant Klebsiella pneumoniae in pediatric wards

Abstract

The emergence of carbapenem-resistant Enterobacteriaceae made the treatment difficult, which has become a significant issue of public health. A sharp increase of carbapenem-resistance rate in Klebsiella pneumoniae was observed in a maternity and child health care hospital in Zunyi, China, in 2014. In 2015 to 2016, carbapenem-resistant Klebsiella pneumoniae (CRKp) isolated from all the clinical samples were analyzed to identify the carbapenem-resistance genes. They were then fingerprinted in order to determine their genetic relationship. Clinical data such as usage of imipenem in 2012 to 2016 and the nosocomial infection surveillance data were analyzed. Thirty-five isolates of CRKp out of 4328 various pathogens were obtained, and bla NDM-1 was identified to be the most common resistant gene present in the CRKp isolates. The fingerprint analysis identified 15 major clusters of CRKp isolates. The bacteria with close proximity relationship tended to be from the same wards. However, a few CRKp isolates from different wards were found to be genetically highly related. The clinical data showed a significantly higher usage of carbapenems in 2012 to 2013 before the CRKp rate sharply increased in 2014. The nosocomial infection surveillance showed an unexpectedly high rate of failures to meet the requirement of the hospital environment hygiene and hand hygiene in the neonatal ward. The increasing isolation rate of CRKp was associated with poorly regulated usage of carbapenems, impropriate medical practices, and the poor hospital environmental hygiene and hand hygiene.

Molecular typing and drug resistance analysis of carbapenem-resistant Klebsiella pneumoniae from paediatric patients in China

“…The results of drug resistance genes showed that all 20 CRKP isolates carried carbapenem resistance genes, of which five isolates only carried bla KPC-2, six isolates only carried blaNDM-1, and the remaining nine isolates carried both carbapenem resistance genes. This indicated that carbapenemase production is the main drug resistance mechanism of CRKP in the hospital, consistent with reports in China [23,24]. The combined analysis of phenotypic drug resistance and the presence of drug resistance genes showed that the presence of aminoglycoside, quinolone, and sulfonamide drug resistance genes was not completely consistent with the results of phenotypic drug resistance analysis, and similar results were obtained in other studies [8,25].…”

Risk Factors and Predictive Nomogram for Carbapenem-Resistant Klebsiella pneumoniae in Children in a Grade 3 First-Class General Hospital in Central China

“… 12 Research findings showed that nosocomial infection surveillance revealed an unexpectedly high rate of failure in neonatal units to meet hospital hygiene and hand hygiene requirements. 5 Bai et al found that nosocomial surveillance systems are needed to limit the spread of the infection caused by these pathogens resulting from the environmental exposure in NICUs. In the delivery room, neonatal intensive care unit (NICU), and the follow-up clinic, in collaboration with the interdisciplinary group, contact precautions and isolation procedures were instituted.…”

“…4 Due to the immature immune system of children, children are more susceptible to CRKP infection, and there are fewer antibiotics available for children than adults, and more complications occur in children, which brings great challenges to clinical treatment. 5 Therefore, there is a need to explore risk factors for CRKP in children to prevent antimicrobial resistance and consequently improve the prognosis. However, there are no scientific techniques or reliable methods to predict the prognosis of patients based on a single factor.…”

Study of the Epidemiological and Mechanistic Differences Between Carbapenem-Resistant Klebsiella pneumoniae Infections in Children and Adults

“…In China, KPC-2 is the predominant carbapenemase enzyme, succeeded by NDM and OXA types. 6 The predominant genotypes of CRKP in pediatric patients can vary significantly by region, 7,8 which contrasts with the more uniform profile observed in adult patients, where KPC-2 is the predominant enzyme. 9 In recent years, there has been a growing incidence of CRKP strains co-producing two or even three different carbapenemase enzymes.…”