Frequency of Bacteremia due to Carbapenemase-producing Enterobacteriaceae in Pediatric Hematology-Oncology Can Be Reduced by Measures of Hospital Infection Control

Objectives: The spread of carbapenemase-producing Enterobacteriaceae (CPE) is an emerging problem in children undergoing cancer-directed chemotherapy. A previous Italian survey reported a threefold increase in CPE colonization rate and a fourfold increase of CPE bloodstream infections in a 2 year-observation time interval. Methods: To assess the efficacy of the measures put in place to control this emergency, a second survey was performed in the years 2016-2017 and the results were compared. Results: The overall rate of colonization was comparable between the two study periods: 0.50% (2016-2017) vs. 0.48% (2012-2013). MDR/CPE bacteremia was now reported in 13 children from six centers. The rate of MDR/CPE bacteremia was 0.12 for 1,000 days of hospitalization (95% CI, 0.07-0.21) and compared favorably with that observed in the previous survey (0.42 for 1,000 days of hospitalization; 95% CI, 0.31-0.57; p

___

  • 1. Tassios GL, Daikos LS, Tzouvelekis A, Markogiannakis M, Psichogiou PT. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev 2012; 25:682–707.
  • 2. Queenan AM, Bush K. Carbapenemases: the versatile b-lactamases. Clin Microbiol Rev 2007; 20:440–58.
  • 3. Tsioutis C, Eichel VM, Mutters NT. Transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae: the role of infection control. J Antimicrob Chemother. 2021; 76 (Supplement 1):i4-i11.
  • 4. Caselli D, Cesaro S, Fagioli F, et al. Incidence of colonization and bloodstream infection with carbapenem-resistant Enterobacteriaceae in children receiving antineoplastic chemotherapy in Italy. Infect Dis 2016; 48:152-5.
  • 5. Iacchini S, Sabbatucci M, Gagliotti C, et al. Bloodstream infections due to carbapenemase-producing Enterobacteriaceae in Italy: results from nationwide surveillance, 2014 to 2017. Euro Surveill. 2019;24(5):1800159.
  • 6. Magiorakos AP, Burns K, Rodríguez Baño J. et al. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control. Antimicrob Resist Infect Control 6, 113 (2017).
  • 7. Arendrup MC, Hope W, Howard SJ. EUCAST Definitive Document E.Def 9.2 Method for the Determination of Broth Dilution Minimum Inhibitory Concentrations of Antifungal Agents for Conidia Forming Moulds; EUCAST: Basel, Switzerland, 2014.
  • 8. Clinical Laboratory Standards Institute. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi; Approved Standard, 2nd ed.; CLSI document M38-A2; Clinical and Laboratory Standards Institute: Wayne, PA, USA, 2008.
  • 9. Martelius T, Jalava J, Kärki T, et al. Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999-2013: Trends, patient characteristics and mortality. Infect Dis 2016; 48:229-34.
  • 10. Marín M, Gudiol C, Garcia-Vidal C, Ardanuy C, Carratalà J. Bloodstream infections in patients with solid tumors: epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single cancer center. Medicine (Baltimore). 2014;93(3):143-9.
  • 11. Avendano E, Raman G, Chan J, McCann E. Burden of carbapenem non-susceptible infections in high-risk patients: systematic literature review and meta-analysis. Antimicrob Resist Infect Control 2020; 9: 193.
  • 12. Viale P, Tumietto F, Giannella M, et al. Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy. Clin Microbiol Infect 2015; 21(3):242-7.
  • 13. Spyridopoulou K, Psichogiou M, Sypsa V, et al. Containing Carbapenemase-producing Klebsiella pneumoniae in an endemic setting. Antimicrob Resist Infect Control 2020; 9(1):102.