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Intestinal colonization of carbapenem-resistant gram-negative bacteria in pediatric hematology patients: risk factors
Huangdu Hu1, Weiyi Huang2,3,4, Shuwei Ruan5
1Department of Infectious Diseases, Center of General Practice Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.
Insights
Carbapenem-resistant gram-negative bacteria (CR-GNB) intestinal colonization affects 13.3% of pediatric hematology patients in China. Younger age, leukemia, lymphoma, and stem cell transplant increase risk, necessitating tailored infection control for this vulnerable group.
Area of Science:
- Infectious Diseases
- Microbiology
- Pediatric Hematology
Background:
- Carbapenem-resistant gram-negative bacteria (CR-GNB) pose a significant threat in healthcare settings.
- Understanding CR-GNB colonization in immunocompromised pediatric populations is crucial for infection control.
- Previous studies have not comprehensively assessed CR-GNB intestinal colonization in Chinese pediatric hematology patients.
Purpose of the Study:
- To determine the prevalence of intestinal CR-GNB colonization in pediatric hematology inpatients across China.
- To identify risk factors associated with CR-GNB colonization in this patient group.
- To characterize the molecular features, including resistance mechanisms and genetic profiles, of colonizing CR-GNB isolates.
Main Methods:
- A multicenter case-control study involving 412 pediatric inpatients with hematological diseases.
- Screening for CR-GNB intestinal colonization, followed by antimicrobial susceptibility testing and whole-genome sequencing of isolates.
- Logistic regression analysis to identify risk factors and comparative analysis with adult patients.
Main Results:
- A prevalence of 13.3% for CR-GNB intestinal colonization was observed, with carbapenem-resistant Enterobacterales (CRE) being most common.
- Independent risk factors included younger age, acute leukemia, lymphoma, and hematopoietic stem cell transplantation (HSCT).
- Molecular analysis revealed NDM enzyme prevalence in specific species, while carbapenem-resistant Klebsiella pneumoniae (CRKP) showed non-carbapenemase-producing resistance mechanisms; pediatric CRE isolates had lower resistance to aminoglycosides and beta-lactamase inhibitor combinations compared to adults.
Conclusions:
- CR-GNB colonization represents a substantial burden with significant molecular diversity in pediatric hematology patients in China.
- Findings highlight the need for pediatric-specific surveillance and infection control strategies.
- Strategies should address species-specific resistance patterns and unique clinical vulnerabilities of this population.
Objectives:
Aims to investigate the prevalence, risk factors, and molecular characteristics of intestinal colonized carbapenem-resistant gram-negative bacteria (CR-GNB) in pediatric hematology inpatients across China.
Methods:
In this multicenter case control study, 412 pediatric inpatients with hematological diseases across China were screened for CR-GNB intestinal colonization. Antimicrobial susceptibility testing and whole-genome sequencing were performed on colonizing isolates. Logistic regression models were used to identify risk factors and construct a predictive nomogram. Comparative analyses between pediatric and adult patients were conducted to assess differences in colonization rates, resistance phenotypes, and resistance gene profiles.
Results:
A total of 13.3% (55/412) of pediatric inpatients were colonized with CR-GNB, with carbapenem-resistant Enterobacterales (CRE) being the dominant group (10.0%, 41/412), followed by carbapenem-resistant Pseudomonas aeruginosa (CRPA) (3.2%, 13/412) and carbapenem-resistant Acinetobacter baumannii (CRAB) (0.2%, 1/412). Independent risk factors for colonization included younger age, acute leukemia, lymphoma, and hematopoietic stem cell transplantation (HSCT). Phylogenetic analyses showed no clonal dissemination and no regional clustering. NDM enzyme was prevalent in carbapenem-resistant E. coli (CREC) and Enterobacter spp., while CRKP isolates were mostly non-carbapenemase-producing, with resistance likely driven by extended-spectrum beta-lactamases (ESBLs) overexpression and porin loss. Compared with adults, pediatric CRE isolates exhibited significantly lower resistance to aminoglycosides and β-lactamase inhibitor combinations.
Conclusions:
This large-scale multicenter study highlights the substantial burden and molecular diversity of CR-GNB colonization in children with hematological diseases. Our findings underscore the need for pediatric-focused surveillance and infection control strategies that reflect species-specific resistance patterns and clinical vulnerabilities unique to this population.
Trial Registration:
ClinicalTrials.gov, registration number NCT05002582. (Registration date: 08 April 2021).
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