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Evaluation of Pediatric Screening for Resistant Pathogens in an Israeli Tertiary Center
Michal Stein1, Halima Dabaja-Younis1, Imad Kassis2
1Pediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel.
Insights
Non-Israeli residents and patients with prior multidrug-resistant (MDR) bacteria screening are at higher risk. Screening indications effectively identified high-risk individuals, but excessive sampling should be reduced.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Antibiotic resistance poses a significant global health challenge, leading to increased patient morbidity and mortality.
- The emergence and spread of multidrug-resistant (MDR) bacteria necessitate continuous surveillance and risk assessment in diverse populations.
Purpose of the Study:
- To evaluate the carriage of multidrug-resistant (MDR) bacteria in pediatric populations.
- To identify risk factors and effective screening indications for MDR bacteria in hospitalized children.
Main Methods:
- A retrospective analysis of screening data from 725 patients under 18 years old between 2015-2016.
- Screening included carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum beta-lactamase (ESBL) producers, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE).
- Risk factors assessed included non-Israeli residency, intensive care unit transfers, high-risk department admissions, previous MDR carriage, and recent hospitalizations.
Main Results:
- Overall, 7% of screening sets were positive, with 22.7% of patients carrying at least one MDR pathogen.
- Non-Israeli residents (40.9%) showed significantly higher MDR carriage rates compared to Israeli residents (19.5%).
- Previous MDR bacteria carriage was the strongest predictor of current carriage (41%).
Conclusions:
- Non-Israeli residents and patients with a history of MDR bacteria carriage are at elevated risk.
- The established screening indications proved effective in identifying high-risk patients for MDR pathogens.
- Strategies to optimize sampling protocols and reduce unnecessary screenings are recommended.
Background:
Antibiotic resistance is a worldwide problem associated with increased morbidity and mortality.
Objectives:
To evaluate multidrug resistant (MDR) bacteria carriage in selected populations.
Methods:
Data were collected from all patients under 18 years who met our internal guidelines from 2015-2016. They were screened for carbapenem-resistant Enterobacteriaceae (CRE), extended spectrum beta-actamase (ESBL), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Indications for screening were non-resident non-Israeli patients (from the Palestinian Authority, Syria, and foreign patients), internal transfers from intensive care units, admission to high-risk departments, recent carriage of MDR bacteria, transfer from other hospitals, and recent hospitalization. Data were analyzed for MDR bacteria from at least one screening site (rectal, nasal, axillary, groin, throat). All data were analyzed per patient and per sample.
Results:
During the study period 185/2632 positive screening sets (7%) were obtained from 725 patients. Of these, 165 patients (22.7%) were positive for at least one pathogen. Significantly fewer Israeli residents (120/615, 19.5%) tested positive compared to non-Israeli residents (45/110, 40.9%; P < 0.001). Past MDR bacteria carriage was the only significant screening indication (25/61, 41%; P < 0.001). CRE, VRE, MRSA, and ESBL prevalence rates were 0.6% (5/771), 0.5% (3/560) 0.5%, 4.2% (37/888), and 33.7% (139/413), respectively. Among non-ESBL carriers, MRSA was predominant with 38 positive cultures (n=34).
Conclusions:
Non-Israeli non-residents and patients with previous positive MDR screening are at higher risk for MDR bacteria. Indications used to identify high-risk patients for drug resistant pathogens were efficacious. More effort is needed to reduce excessive sampling.
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