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Modifiable risk factors associated with later gut decolonization of carbapenem-resistant Gram-negative bacteria in
V-M Darda1, E Iosifidis1, C Antachopoulos1
13(rd) Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, and Hippokration General Hospital, Thessaloniki, Greece.
Insights
Later gut decolonization of carbapenem-resistant Gram-negative bacteria (CRGNB) in children is influenced by factors like immunosuppression, carbapenem use, and hospitalization duration. Targeted screening and prolonged contact precautions are recommended for at-risk pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Hospital Epidemiology
Background:
- Nosocomial infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB) are linked to increased mortality and extended hospital stays.
- Effective decolonization of CRGNB in pediatric patients is crucial for public health and clinical outcomes.
Purpose of the Study:
- To identify modifiable and non-modifiable risk factors associated with delayed gut decolonization of CRGNB in hospitalized children.
- To inform strategies for managing CRGNB colonization in pediatric populations.
Main Methods:
- A cohort of pediatric CRGNB carriers (0-16 years) hospitalized between 2018-2019 was studied.
- Rectal swab cultures were collected weekly during hospitalization and monthly post-discharge for 12 months.
- Cox regression analysis was used to determine risk factors for delayed CRGNB decolonization, defined as three consecutive negative cultures.
Main Results:
- 5.4% of 130 CRGNB carriers remained colonized after 12 months.
- Factors associated with delayed decolonization included immunosuppression, carbapenem and proton pump inhibitor (PPI) use, duration of hospitalization, readmissions, abdominal surgery, and urinary catheter use.
- Duration of steroid administration also correlated with delayed decolonization.
Conclusions:
- Carbapenems, PPIs, steroids, immunosuppression, urinary catheters, hospitalizations, readmissions, and abdominal surgery are significant risk factors for prolonged CRGNB colonization in children.
- Pediatric patients at risk require targeted screening and extended contact precautions.
- Meticulous application of contact precautions is essential for known carriers at risk of persistent CRGNB colonization.
Background:
Nosocomial infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB) are associated with increased mortality and prolonged hospitalization; thus, later CRGNB decolonization has significant clinical and public health implications.
Aim:
To investigate modifiable/non-modifiable risk factors for CRGNB later gut decolonization in children.
Methods:
CRGNB carriers (aged from one day to 16 years) hospitalized in a tertiary level hospital (2018-2019) were included. Upon CRGNB carriage detection, rectal swab cultures were taken weekly, if patients were hospitalized, and monthly after discharge for 12 months. CRGNB decolonization was defined as three consecutive negative rectal-swab cultures obtained ≥1 week apart. Modifiable (treatment administered/medical devices) and non-modifiable (age/gender/comorbidities) risk factors were recorded. Cox regression for later CRGNB decolonization was performed.
Findings:
One hundred and thirty CRGNB carriers were recorded. After 12 months, 5.4% remained carriers. Risk factors for later decolonization were immunosuppression (hazard ratio: 0.52; 95% confidence interval: 0.31-0.87), carbapenems (0.52; 0.30-0.91), proton pump inhibitors (PPIs) (0.39; 0.24-0.64) and their duration of use, duration of hospitalization (0.90; 0.81-0.92, per 10 days), number of readmissions (0.90; 0.86-0.96), abdominal surgery (0.33; 0.17-0.65), urinary catheter (0.42; 0.24-0.76), and duration of steroid administration per 10 days (0.86; 0.84-0.88).
Conclusions:
Carbapenems, PPIs and their duration of use, duration of steroids use, immunosuppression, urinary catheter, readmissions, duration of hospitalization, and abdominal surgery are associated with later CRGNB decolonization among children. Paediatric patients at risk of later decolonization should be under targeted screening and pre-emptive contact precautions. Known carriers at risk of later CRGNB decolonization should be under meticulously applied contact precautions for longer durations.
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