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Increased rate of multidrug-resistant gram-negative bacterial infections in hospitalized immunocompromised pediatric
Sarah Khafaja1,2, Yara Salameh1, Celina F Boutros1
1Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon.
Insights
Multidrug-resistant Gram-negative bacterial infections are a major threat in immunocompromised children. High rates of resistance, particularly in E. coli and K. pneumoniae, were observed, necessitating updated treatment guidelines and stewardship programs.
Area of Science:
- Medical Microbiology
- Pediatric Infectious Diseases
- Public Health
Background:
- Multidrug-resistant Gram-negative bacteria (MDR GNB) pose a significant global health challenge.
- Immunocompromised pediatric patients face a heightened risk of severe infections from these pathogens.
Purpose of the Study:
- To determine the frequency of MDR GNB infections in immunocompromised children.
- To identify risk factors associated with these infections.
- To characterize the antimicrobial resistance patterns of GNB isolates.
Main Methods:
- Retrospective observational study conducted at AUBMC from 2009 to 2017.
- Inclusion of immunocompromised pediatric patients (≤18 years) with GNB infections from sterile or non-sterile sites.
- Data collection on patient demographics, pathogens, and antimicrobial susceptibility.
Main Results:
- 381 infection episodes in 242 patients were identified; MDR GNB accounted for 72% of cases.
- Alarmingly high MDR rates were found in Escherichia coli (95.7%) and Klebsiella pneumoniae (82.7%).
- Independent risk factors included thrombocytopenia, chemotherapy, and prior colonization/infection.
Conclusions:
- The study highlights the high and increasing prevalence of MDR GNB infections in immunocompromised pediatric patients.
- Urgent revision of treatment guidelines and implementation of antimicrobial stewardship are crucial.
- Enhanced infection control policies are needed to mitigate the spread of MDR GNB.
Introduction:
Multidrug resistant Gram-negative bacterial infections are considered a major public health threat. Immunocompromised pediatric patients are at a great risk of severe or overwhelming infections. The aim of this study was to describe the frequency of infections with multidrug resistant (MDR) Gram-negative bacteria (GNB) in immunocompromised pediatric patients and to determine the risk factors. In addition, we aimed to identify the antimicrobial resistance patterns of these isolates.
Materials And Methods:
This was a retrospective observational study conducted at the American University of Beirut Medical Center (AUBMC) from 2009 to 2017. The study included immunocompromised patients 18 years of age or younger with infections caused by Gram-negative bacteria isolated from a sterile site, or nonsterile site in the setting of clinical infection.
Results:
A total of 381 episodes of infection with GNB in 242 immunocompromised pediatric patients were identified. The mean age was 7.7 years. The most common pathogens were Enterobacterales followed by Pseudomonas and Acinetobacter spp. MDR GNB infections predominated causing 72% of the episodes, with alarming MDR rates among Escherichia coli (95.7%) and Klebsiella pneumoniae (82.7%). The overall rate of MDR GNB isolated increased from 62.7% in 2015 to 90% in 2017. Thrombocytopenia, chemotherapy and previous colonization or infection with the same organism during the past 12 months were found to be independent risk factors for infection with MDR GNB.
Conclusion:
This study provides data on the epidemiology of infections with MDR GNB in immunocompromised pediatric patients and illustrates the alarmingly high prevalence of these infections. This necessitates the frequent revisiting of treatment guidelines in these high-risk patients and the implementation of judicious antimicrobial stewardship programs and infection control policies to stabilize or decrease the prevalence of these infections.
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