Epidemiology of carbapenemase-producing Enterobacteriaceae in a pediatric hospital in a country with high endemicity

Elio Castagnola, Paola Tatarelli, Alessio Mesini, Ivana Baldelli, Daniela La Masa, Roberto Biassoni, Roberto Bandettini

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Little is known about epidemiology of carbapenemase-producing Enterobacteriaceae (CPE) in children. Aim of this study was to describe CPE epidemiology in a tertiary care pediatric hospital in Italy that admits patients coming from geographic areas with high diffusion of CPE.

METHODS: Prospective evaluation of the proportion and rates per 100,000 hospital discharges (D) or hospitalization-days (HD) of invasive infections due to CPE from 2013 to 2017 and of CPE infections and colonizations from 2014 to 2017. Disease-preventing strategies comprised patients' screening at admission, pre-emptive contact isolation precautions pending cultures results, and bundles for prevention of healthcare associated infections.

RESULTS: From 2013 to 2017 CPE represented 3.5% of all invasive infections due to Enterobacteriaceae, with rates ranging 7.30-14.33 for D and 1.03-2.06 for HD, without major changes over time. On the contrary, overall rates of isolates increased from 83.03 to 191.34 for D and from 12.21 to 28.35 for HD. The intra-hospital diffusion consisted of 2 small outbreaks without invasive diseases in 2014-2015, and sporadic, not epidemiologically-related cases in 2016-2017. Globally, Escherichia coli and Klebsiella pneumoniae represented 64% of identified CPE, while 70% of carbapenemases identified were metallo-beta-lactamases (VIM or NDM), with changes over time.

CONCLUSIONS: In our center metallo-beta lactamases were the most frequently identified carbapenemases in Enterobacteriaceae and E. coli and K. pneumoniae the most frequently isolated pathogens carrying these enzymes. A proactive management strategy was effective in containing in-hospital spreading.

Original languageEnglish
Pages (from-to)270-274
Number of pages5
JournalJournal of Infection and Public Health
Volume12
Issue number2
DOIs
Publication statusPublished - Nov 28 2018

Keywords

  • Carbapenem-Resistant Enterobacteriaceae/classification
  • Child
  • Child, Preschool
  • Cross Infection/epidemiology
  • Disease Transmission, Infectious/prevention & control
  • Enterobacteriaceae Infections/epidemiology
  • Hospitals, Pediatric
  • Humans
  • Infection Control/methods
  • Italy/epidemiology
  • Prospective Studies
  • Tertiary Care Centers

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