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Bacterial Etiology and Antimicrobial Resistance Pattern of Pediatric Bloodstream Infections in Beijing, 2015-2019
Zhi-Yong Lyu1, Jing-Hui Zhen1, Qing-Ying Meng1
1Department of Clinical Laboratory Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, People's Republic of China.
Insights
This study reveals common bacteria causing pediatric bloodstream infections (BSIs) in Beijing and their antibiotic resistance patterns. Understanding these trends is crucial for effective treatment and combating antimicrobial resistance.
Area of Science:
- Medical Microbiology
- Pediatric Infectious Diseases
- Antimicrobial Resistance
Background:
- Bloodstream infections (BSIs) are a significant cause of illness and death in children.
- Empirical broad-spectrum antibiotic treatment for BSIs can be costly and contribute to antimicrobial resistance.
- Effective diagnosis and treatment require understanding local pathogen distribution and resistance patterns.
Purpose of the Study:
- To provide evidence for diagnosing and treating pediatric BSIs.
- To identify the primary bacterial pathogens causing BSIs in children.
- To characterize the antibiotic resistance patterns of these pathogens.
Main Methods:
- A retrospective analysis of 2544 bacterial isolates from 2368 pediatric BSI patients over 5 years in Beijing.
- Identification of bacterial species and assessment of antimicrobial susceptibility.
- Evaluation of resistance to key antibiotics, including methicillin, carbapenems, and penicillin.
Main Results:
- The most common pathogens were *K. pneumoniae* (12.1%), *S. aureus* (11.5%), *E. coli* (11.2%), and *E. faecium* (11.2%).
- High rates of antibiotic resistance were observed: 30.0% for methicillin-resistant *S. aureus* (MRSA), 81.7% for coagulase-negative *Staphylococcus* (CoNS), 50.8% for carbapenem-resistant *K. pneumoniae* (CRKPN), and significant resistance in *E. coli*, *S. pneumoniae*, *P. aeruginosa*, and *A. baumannii*.
- Gram-positive bacteria were the predominant pathogens, with CoNS showing higher resistance than *S. aureus*.
Conclusions:
- Gram-positive bacteria, particularly CoNS, are major contributors to pediatric BSIs with significant antibiotic resistance.
- *K. pneumoniae* and *E. coli* are leading gram-negative pathogens with high resistance rates.
- Tailoring antimicrobial therapy based on identified pathogens and susceptibility testing is critical for effective BSI management in children.
Purpose:
Bloodstream infections (BSIs) was an essential cause of morbidity and mortality in children. Empiric broad-spectrum treatment of BSIs may be costly and unable to effectively eliminate the correct pathogenic microbes, resulting in downstream antimicrobial resistance. The purpose was to provide evidence for diagnosis and treatment of bloodstream infections in pediatrics, by revealing the pathogen distribution and antibiotic resistance pattern of BSIs.
Methods:
In this 5-year study, a total of 2544 pathogenic bacteria stains, isolated from 2368 patients with BSI, were retrospectively analyzed, to define the species distribution and the antimicrobial resistance pattern in Beijing.
Results:
The most frequently isolated pathogenic bacteria were K. pneumoniae (12.1%), S. aureus (11.5%), E. coli (11.2%), and E. faecium (11.2%). Hematological malignancies were the most common disease among patients with underlying conditions. Methicillin resistance was detected in 30.0% of S. aureus and 81.7% of coagulase-negative Staphylococcus (CoNS), respectively. The detection rates of carbapenem-resistant-E. coli (CRECO) and carbapenem-resistant-K. pneumoniae (CRKPN) were 10.8% and 50.8%, respectively. In terms of 122 isolates of S. pneumonia, 5 isolates (4.1%) were penicillin-resistant Streptococcus pneumoniae (PRSP); meanwhile, 50 isolates (41.0%) were penicillin-intermediate Streptococcus pneumoniae (PISP). Among the non-fermentative gram-negative bacilli isolates, 22.8% and 26.9% of the P. aeruginosa, were resistant to imipenem and meropenem. Furthermore, the resistance rates of A. baumannii to imipenem and meropenem both were 54.5%.
Conclusion:
In the study, we demonstrated the characteristics of bloodstream infections and antimicrobial susceptibility pattern of pediatrics in Beijing. Gram positive bacteria were the main pathogens of BSIs. CoNS strains presented even higher resistance to multiple antibiotics, including methicillin, than S. aureus. K. pneumoniae and E. coli represent the most common isolated gram-negative bacteria and exhibited high resistance to a variety of antimicrobial agents. Therefore, it was of critical importance to implement appropriate antimicrobial medication according to pathogen distribution and drug susceptibility test.
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