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Antibiotic-resistant gram-negative organisms in pediatric chronic-care facilities
Karen Lidsky1, Claudia Hoyen, Ann Salvator
1Department of Pediatrics, Rainbow Babies and Children's Hospital of the University Hospitals of Cleveland, Cleveland, OH, 44106, USA. karen.lidsky@uhhs.com
Abstract:
This study was designed to define the prevalence of colonization with antibiotic-resistant gram-negative rectal specimens were obtained from subjects residing in 2 pediatric extended-care facilities and were processed to identify gram-negative organisms resistant to ceftazidime, gentamicin, meropenem, and piperacillin-tazobactam. Horizontal transmission was assessed by analyzing all resistant isolates by pulsed-field gel electrophoresis. Forty percent of subjects were colonized with >/=1 resistant bacillus; >60% of organisms were resistant to >/=2 of the antibiotics tested. Colonization was disproportionate among residents with a tracheostomy or other prosthesis. More than 65% of colonized subjects shared 1 organism with another resident, with cross-colonization occurring among both enteric and nonenteric species. Children residing in chronic-care facilities represent a large reservoir for resistant bacilli. Such colonization may be amenable to simple barrier infection-control procedures.
Insights
Antibiotic-resistant gram-negative bacteria colonize 40% of children in extended-care facilities. Cross-colonization is common, highlighting these children as a reservoir for resistant organisms.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Pediatric extended-care facilities can harbor antibiotic-resistant organisms.
- Understanding colonization prevalence is crucial for infection control.
Purpose of the Study:
- To determine the prevalence of antibiotic-resistant gram-negative bacteria colonization in pediatric extended-care facilities.
- To assess horizontal transmission of these resistant organisms.
Main Methods:
- Rectal specimens were collected from residents of two pediatric extended-care facilities.
- Organisms were identified for resistance to ceftazidime, gentamicin, meropenem, and piperacillin-tazobactam.
- Pulsed-field gel electrophoresis (PFGE) was used to analyze resistant isolates for horizontal transmission.
Main Results:
- Forty percent of subjects were colonized with at least one resistant gram-negative bacillus.
- Over 60% of identified organisms exhibited resistance to two or more antibiotics.
- Colonization was more frequent in residents with tracheostomies or prostheses.
- Over 65% of colonized subjects shared an organism with another resident, indicating cross-colonization.
Conclusions:
- Children in chronic-care facilities represent a significant reservoir for antibiotic-resistant bacteria.
- Simple barrier infection-control procedures may help manage colonization.
- Further research into transmission dynamics and control strategies is warranted.