Intestinal Colonization and Subsequent Nosocomial Infection with Carbapenem-Resistant Organisms in a PICU: Risk...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pediatric Health

Background:

• Rising rates of carbapenem-resistant organism (CRO) colonization and infection in pediatric intensive care units (PICUs).
• PICU patients are vulnerable due to comorbidities, invasive procedures, prolonged hospitalization, and broad-spectrum antibiotic use.
• Colonized patients serve as reservoirs for nosocomial transmission, threatening vulnerable children and healthcare workers.

Purpose of the Study:

• To analyze risk factors for intestinal CRO colonization in critically ill children.
• To identify factors contributing to subsequent nosocomial CRO infections in colonized pediatric patients.
• To determine molecular homology between colonizing and infecting CRO strains.

Main Methods:

• Active screening for intestinal CRO colonization in 1069 PICU admissions (January 2021 - September 2022).
• Risk factor analysis using logistic regression for colonization and infection.
• Pulsed-field gel electrophoresis (PFGE) to confirm strain homology.

Main Results:

• A 7.2% intestinal CRO colonization rate (77/1069 children) was detected.
• Independent risk factors for colonization: neuromuscular disease (OR 7.048) and longer hospital stay (OR 1.063).
• Independent risk factors for infection in colonized children: carbapenem exposure (OR 4.041), absence of contact isolation (OR 0.033), and longer hospital stay (OR 1.083). 15/77 colonized children developed homologous infections.

Conclusions:

• Intestinal CRO colonization significantly elevates the risk of subsequent homologous nosocomial infection in PICU patients.
• Rational carbapenem use is essential to mitigate CRO development and spread.
• Prompt contact isolation for colonized children and reduced hospitalization duration are critical for infection control.