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The Prevalence and Molecular Epidemiology of Multidrug-Resistant Enterobacteriaceae Colonization in a Pediatric
Nuntra Suwantarat1, Latania K Logan2, Karen C Carroll1
11Division of Medical Microbiology,Johns Hopkins Medical Institutions,Baltimore,Maryland,USA.
Insights
Approximately 4% of children admitted to the pediatric intensive care unit (PICU) are colonized with multidrug-resistant Enterobacteriaceae. An additional 4% acquire these resistant organisms during their PICU stay, indicating diverse introduction sources.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pediatric Critical Care
Background:
- Multidrug-resistant (MDR) Enterobacteriaceae, including those producing extended-spectrum β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs), and carbapenemases, pose a significant threat in healthcare settings.
- Understanding the colonization and acquisition patterns of these resistant organisms in vulnerable pediatric populations is crucial for infection control.
Purpose of the Study:
- To determine the prevalence of colonization with MDR Enterobacteriaceae upon admission to a pediatric intensive care unit (PICU).
- To assess the incidence of MDR Enterobacteriaceae acquisition among pediatric patients during their PICU stay.
- To characterize the genetic determinants and relatedness of acquired MDR Enterobacteriaceae strains.
Main Methods:
- A prospective study was conducted in a 40-bed PICU over a 6-month period.
- Rectal surveillance swabs were collected from pediatric patients upon admission and weekly thereafter.
- Molecular characterization, including DNA microarray and multilocus sequence typing, was performed on Enterobacteriaceae isolates with characteristic resistance profiles.
Main Results:
- The prevalence of MDR Enterobacteriaceae colonization upon PICU admission was 4.3% (n=37), comprising 2.8% ESBLs, 1.3% pAmpCs, and 0.2% carbapenemases.
- Among 157 patients with subsequent swabs, 6 children (3.8%) acquired incident MDR Enterobacteriaceae during their PICU stay.
- One pAmpC acquisition was linked to an isolate from another patient, and acquired strains were heterogeneous, suggesting multiple introduction sources.
Conclusions:
- Approximately 4% of children admitted to the PICU are colonized with MDR Enterobacteriaceae.
- An additional 4% of children remaining in the PICU for at least one week acquire these resistant organisms.
- The heterogeneity of acquired MDR Enterobacteriaceae suggests diverse introduction mechanisms into the PICU, necessitating comprehensive infection control strategies.
Objective:
To determine the prevalence and acquisition of extended-spectrum β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs), and carbapenemases ("MDR Enterobacteriaceae") colonizing children admitted to a pediatric intensive care unit (PICU).
Design:
Prospective study.
Setting:
40-bed PICU.
Methods:
Admission and weekly thereafter rectal surveillance swabs were collected on all pediatric patients during a 6-month study period. Routine phenotypic identification and antibiotic susceptibility testing were performed. Enterobacteriaceae displaying characteristic resistance profiles underwent further molecular characterization to identify genetic determinants of resistance likely to be transmitted on mobile genetic elements and to evaluate relatedness of strains including DNA microarray, multilocus sequence typing, repetitive sequence-based PCR, and hsp60 sequencing typing.
Results:
Evaluating 854 swabs from unique children, the overall prevalence of colonization with an MDR Enterobacteriaceae upon admission to the PICU based on β-lactamase gene identification was 4.3% (n=37), including 2.8% ESBLs (n=24), 1.3% pAmpCs (n=11), and 0.2% carbapenemases (n=2). Among 157 pediatric patients contributing 603 subsequent weekly swabs, 6 children (3.8%) acquired an incident MDR Enterobacteriaceae during their PICU stay. One child acquired a pAmpC (E. coli containing bla DHA) related to an isolate from another patient.
Conclusions:
Approximately 4% of children admitted to a PICU were colonized with MDR Enterobacteriaceae (based on β-lactamase gene identification) and an additional 4% of children who remained in the PICU for at least 1 week acquired 1 of these organisms during their PICU stay. The acquired MDR Enterobacteriaceae were relatively heterogeneous, suggesting that a single source was not responsible for the introduction of these resistance mechanisms into the PICU setting.
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