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CRE infections increase morbidity, mortality among immunosuppressed children in Italy
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Carbapenem-resistant Enterobacteriaceae infections among children in Italy with immunosuppression and oncologic diseases were associated with significant morbidity and mortality, according to study findings.
“CRE infections occur mainly among critically ill pediatric patients with serious underlying conditions, especially malignancy- or transplant-associated immunosuppression,” Carlotta Montagnani, MD, associate professor in the department of health sciences at the University of Florence, and colleagues wrote. “CRE generally show a multidrug-resistant profile, with few residual therapeutic options, especially in children. As a result, severe infections caused by CRE have significant morbidity, mortality, prolongation of hospitalization and health care costs.”
Montagnani and colleagues conducted a retrospective, observational, multisite study of patients with CRE infection or colonization who were hospitalized during a 3-year period in Italy. Sixty-nine patients presented with infections or colonizations (n = 74). Positive CRE cases were defined by clinical signs or symptoms and clinical infection, which included sepsis (41.2%), respiratory infections (26.5%) and urinary tract infections (20.6%). The patients deemed as colonized were asymptomatic at the time of CRE isolation. Klebsiella pneumoniae (71%) were the most frequently isolated CRE.
Children with oncologic diseases — including leukemia and solid tumors — and transplant-associated immunosuppression comprised 47.1% of the study group and had an increased risk for death (OR = 15.67, 95% CI, 1.76-139.6). Patients treated with colistin also displayed a lower survival rate vs. other antimicrobials (OR = 10.38, 95% CI, 1.24-87.05), and those with immunosuppressive/oncologic disease had greater risk for mortality (OR = 15.67; 95% CI, 1.76-139.6). The children with CRE infections had longer hospital stays (47 vs. 6 days; P < .001) and duration of disease (41 vs. 4 days; P < .001) compared with colonized children. In addition, they experienced longer antimicrobial treatment (20.5 vs. 0 days; P < .001).
“Antibiotic choice should be addressed by antibiogram, site of infection and expert consultation,” the researchers wrote. “In Italy, where CRE are rapidly spreading, active screening of CRE carriers should be considered, especially in high-risk wards. Antimicrobial stewardship programs should be implemented to improve the use of antibiotics and reduce antibiotic resistance.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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