Risk Factors Associated with Colonization of Intestine by Carbapenem Resistant Enterobacteriaceae in a Pediatric ICU

Abstract

Objectives: Asymptomatic colonization of the gastrointestinal tract by Carbapenem Resistant Enterobacteriaceae (CRE) constitutes a reservoir for transmission that may remain unidentified in hospitals that do not implement active surveillance testing. Aim: To assess the magnitude of colonization of carbapenem resistant Enterobacteriaceae and to analyze various risk factors associated with this colonization in children admitted in PICU. Methods: Three-hundred patients admitted to Pediatric Intensive Care Unit (ICU) which tested negative for CRE colonization upon admission were studied for colonization of intestine by CRE after two days of stay in ICU. Risk factors were analyzed with respect to CRE colonized and non CRE colonized groups. Results: Thirty-two (10.67%) patients were found to be colonized with CRE; Klebsiella pneumoniae being the predominant species followed by Escherichia coli using CDC screening method. Univariate analysis of risk factors revealed acute bronchopneumonia, acute febrile illness, Gullian-Barre syndrome to be significantly associated with colonization with CRE. Also, sepsis, presence of central line, mechanical ventilation, protein energy malnutrition and intake of steroids, Piperacillin-Tazobactam was found to be highly significant (p<0.001). The odds of developing colonization were significantly higher in children with renal and respiratory disease, sepsis and with intake of broad-spectrum antibiotics. Conclusions: Antimicrobial resistance is a huge public health problem in developing countries and these colonized patients can act as reservoirs of multi drug resistant bacteria resulting in untreatable healthcare associated infections. Large scale epidemiological surveillance studies of CRE using affordable phenotypic methods along with stringent infection prevention control strategies are required. J Microbiol Infect Dis 2020; 10(2):75-81.

Keywords

• Carbapenem-Resistant Enterobacteriaceae,CRE,Colonization,Risk factors

References

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