Epidemiology of carbapenemase-producing Enterobacteriaceae in a pediatric hospital in a country with high endemicity. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Castagnola, Elio; Tatarelli, Paola; Mesini, Alessio; Baldelli, Ivana; La Masa, Daniela; Biassoni, Roberto; Bandettini, Roberto
• Is Part Of: Journal of infection and public health. Volume 12:Issue 2(2019)
• Page Start: 270
• Page End: 274
• Publication Date: 2019-03
• Subjects: Carbapenemase -- Enterobacteriaceae -- Pediatrics; Communicable diseases -- Periodicals; Public health -- Periodicals; Epidemiology -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Medical microbiology -- Periodicals; 614.4
• DOI: 10.1016/j.jiph.2018.11.003
• Languages: English
• ISSNs: 1876-0341

Abstract

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.