Sensitivity Profile of Carbapenem-Resistant Enterobacteriaceae and Therapeutic Outcome in Children in Syria

Abstract

Carbapenem-Resistant Enterobacteriaceae (CRE) threaten public health because the infections they cause carry a high mortality rate and limited treatment options. Few studies focus on these organisms in children compared to the number of the ones carried out on adults. Therefore, the importance of our research is to contribute to broadening our knowledge on the effects of these organisms in children. The objective of our research was to determine each of the following: the sensitivity profile of CRE, available treatment options for dealing with these bacteria, the therapeutic outcome, and the factors affecting this outcome. Our study design was a prospective, single-centre analytical cohort study. Samples were collected from the Children’s University Hospital in Damascus, which conatins 389 beds and 60 incubators. Disk diffusion was used to examine bacterial susceptibility; some samples were tested in BD Phoenix system. Our research examined antibiotics resistance rates, duration to treatment response, and mortality rate. The research sample included 277 samples, 125 of which were resistant to Carbapenem. High resistance to most of the available antibiotics characterized the Carbapenem Resistant Enterobacteriaceae strains. Colistin, Imipenem and Amikacin were the most used antibiotics in our study; one or two antibiotics were used in most cases. Moreover, the mortality rate was 42.4%, and most of the deaths were due to infection itself. The median duration of treatment response was 8.4 days, and the factors were associated with a statistically significant higher mortality rate (age less than one month, the use of certain antibiotics in treatment such as Piperacillin-Tazobactam, and association with respiratory tract infection). Regarding response to treatment, there was no significant difference between Resistant and Non-Resistant Carbapenem Enterobacteriaceae in terms of duration. Enterobacteriaceae resistance to Carbapenems caused a very high mortality rate. Our treatment options were limited; consequently, the introduction of novel antibiotics in our treatment options is required.