Carbapenem-resistant Klebsiella pneumoniae gut colonization and subsequent infection in pediatric intensive care units in shanghai, China.

IF 3.6 2区医学 Q1 MICROBIOLOGY

Annals of Clinical Microbiology and Antimicrobials Pub Date : 2025-07-03 DOI:10.1186/s12941-025-00808-5

Hongyan Guan, Jingxian Liu, Jiajia Yu, Kanglin Guo, Feng Chen, Jing Yu, Ying Liu

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引用次数: 0

Abstract

Background: It has been revealed that carbapenem-resistant Klebsiella pneumoniae (CRKP) colonization is closely associated with subsequent clinical infections. This study aimed to investigate the resistance and epidemiology of CRKP isolated from anal swabs and subsequent clinical infection specimens in two pediatric intensive care unit (ICU) departments. Clinical characteristics were analyzed to identify the risk factors of CRKP infection.

Methods: A 3-year retrospective study was carried out in pediatric intensive care units (PICU) and neonatal intensive care units (NICU). CRKP isolates from colonization and infection samples were characterized by testing resistance genes and multilocus sequence typing (MLST). The results of MLST were analyzed to derive CCs by Bionumeric 8.0. Clinical variables such as gestational age, birth weight, mode of delivery, underlying diseases, exposure of antimicrobial agents, history of surgery, length of hospital stay, and prognosis were collected through the electronic medical record system and analyzed by SPSS 22.0.

Results: Of the 2225 patients who were screened for CRE colonization, 7.42% of patients were detected positive. The incidence of subsequent infection was 18.18%. Carbapenemase genes bla_KPC-2 and bla_NDM-1 were the most prevalent in the colonization and infection of CRKP. The majority of CRKP isolated from anal swabs and infection samples belonged to CC11/ST11. The distribution of CC11 in the PICU was significantly higher than in NICU. ST11/bla_KPC-2 was significantly higher in infection CRKP isolates. Age older than one year and usage of carbapenems within 3 months prior to detection of CRKP colonization were independent risk factors for CRKP clinical infection.

Conclusion: The main prevalence of CRKP varies in different departments. Colonization of ST11/bla_KPC-2 CRKP may increase the incidence of subsequent infections in pediatric ICU patients. Age and usage of carbapenems could increase the risk of CRKP infection in this study.

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中国上海儿科重症监护病房耐碳青霉烯肺炎克雷伯菌肠道定植及随后感染

背景：碳青霉烯耐药肺炎克雷伯菌（CRKP）定植与随后的临床感染密切相关。本研究旨在调查两个儿科重症监护病房（ICU）肛门拭子和随后的临床感染标本中分离的CRKP的耐药性和流行病学。分析临床特点，确定CRKP感染的危险因素。方法：对小儿重症监护病房（PICU）和新生儿重症监护病房（NICU）进行为期3年的回顾性研究。通过耐药基因检测和多位点序列分型（MLST）对定植和感染样品分离的CRKP进行鉴定。用Bionumeric 8.0对MLST结果进行分析，得出CCs。通过电子病历系统收集患者的胎龄、出生体重、分娩方式、基础疾病、抗菌药物暴露、手术史、住院时间、预后等临床变量，并采用SPSS 22.0软件进行分析。结果：在2225例接受CRE定植筛查的患者中，7.42%的患者检测出阳性。后续感染发生率为18.18%。碳青霉烯酶基因blaKPC-2和blaNDM-1在CRKP的定植和感染中最为普遍。从肛门拭子和感染样本中分离的CRKP大部分属于CC11/ST11。CC11在PICU的分布明显高于NICU。ST11/blaKPC-2在感染CRKP的分离株中显著升高。年龄大于1岁，在检测到CRKP定植前3个月内使用碳青霉烯类药物是CRKP临床感染的独立危险因素。结论：CRKP在不同科室的主要患病率存在差异。ST11/blaKPC-2 CRKP的定植可能会增加儿科ICU患者后续感染的发生率。本研究中，年龄和碳青霉烯类药物的使用可能增加CRKP感染的风险。

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来源期刊

Annals of Clinical Microbiology and Antimicrobials MICROBIOLOGY-

CiteScore

8.60

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases. Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.