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

Year 2020, Volume: 10 Issue: 02, 75 - 81, 29.11.2020

Sonal Saxena Suresh Kumar Virender Kumar Ravinder Kaur

https://doi.org/10.5799/jmid.748690

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

• 1. Xu Y, Gu B, Huang M, et al. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000-2012 in Asia. J Thorac Dis 2015; 7(3):376-385. 2. Litzow JM, Gill CJ, Mantaring JB, et al. High frequency of multidrug-resistant gram-negative rods in 2 neonatal intensive care units in the Philippines. Infect Control Hosp Epidemiol 2009; 30:543-549. 3. Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality Antimicrob Agents Chemother 2008; 52:1028-1033. 4. Borer A, Saidel-Odes L, Riesenberg K, et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009; 30:972–6. 5. Carbapenem resistant Enterobacteriaceae: CRE definition. Available from: http://www.cdc.gov/hai/organisms/cre/definition.html [Accessed June 15, 2019] 6. Maamar E, Ferjani S, Jendoubi A, et al. High Prevalence of Gut Microbiota Colonization with Broad-Spectrum Cephalosporin Resistant Enterobacteriaceae in a Tunisian Intensive Care Unit. Front Microbiol 2016; 7:1859. 7. Mittal G, Gaind R, Kumar D, et al. Risk factors for fecal carriage of carbapenemase producing Enterobacteriaceae among intensive care unit patients from a tertiary care center in India BMC Microbiol 2016;16:138. 8. Bonten MJ, Weinstein RA. The role of colonization in the pathogenesis of nosocomial infections. Infect Control Hosp Epidemiol 1996; 17:193–200. 9. Tischendorf J, Almeida de Avila R, Nasia Safdar N. Risk of infection following colonization with carbapenem- resistant Enterobactericeae: A systematic review. Am J Infect Control 2016; 44(5): 539–543. 10. Center for Disease Control and Prevention. Laboratory Protocol for Detection of Carbapenem- Resistant or Carbapenemase-Producing, Klebsiella spp. and E. coli from Rectal Swabs. Available at: https://www.cdc.gov/HAI/pdfs/labSettings/Klebsiell a_or_Ecoli.pdf. 11. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017. 12. Wiener-Well Y, Rudensky B, Yinnon AM, et al. Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalized patients during a national outbreak. J Hosp Infect 2010; 74:344-349. 13. Turner P, Pol S, Soeng S, et al. Turner C High Prevalence of Antimicrobial-resistant Gram-negative Colonization in Hospitalized Cambodian Infants. Pediatric Infect Dis J 2016; 35:856-861. 14. Tran DM, Larsson M, Olson L et al., High prevalence of colonisation with carbapenem-resistant Enterobacteriaceae among patients admitted to Vietnamese hospitals: Risk factors and burden of disease, J Infect 2019; 3 https: //doi.org/10.1016/j.jinf.2019.05.013 15. Lowe CF, Kus JV, Salt N, et al. Nosocomial transmission of New Delhi Metallo-β-Lactamase-1-producing Klebsiella pneumoniae in Toronto, Canada. Infect Control Hosp Epidemiol 2013; 34:49–55. 16. Jaiswal SR, Gupta S, Kumar RS, et al. Gut colonization with carbapenem-resistant Enterobacteriaceae adversely impacts the outcome in patients with hematological malignancies: results of a prospective surveillance study. Mediterr J Hematol Infect Dis 2018; 10(1): e2018025, http://dx.doi.org/10.4084/MJHID.2018.025 17. Sandhu R, Aggarwal A, Sayal P, Kumar S. Intestinal carriage of drug‐resistant Gram‐negative bacteria belonging to family Enterobacteriaceae in children aged 3–14 years: An emerging threat. Int J Health Allied Sci 2019; 8:108‐115.