Pediatric carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a high-prevalence region in the United States.
Pediatric carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a high-prevalence region in the United States.
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DOI：
10.1097/inf.0000000000000471
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发表时间：
2015-01
期刊：
影响因子：
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通讯作者：
Weissman SJ
中科院分区：
文献类型：
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作者：
Pannaraj PS;Bard JD;Cerini C;Weissman SJ
碳青霉烯类耐药肠杆菌科（CRE）引起的感染在全球范围内呈上升趋势，但在儿科人群中尚未得到充分描述。本研究描述了美国一家独立儿童医院CRE感染的临床、表型和基因型特征。CRE定义为任何临床肠杆菌科分离株，对亚胺培南或美罗培南不敏感，但通过常规抗菌药物敏感性试验确定对头孢曲松、头孢噻肟和头孢他啶耐药。采用改良Hodge试验筛选碳青霉烯酶的产生。回顾临床资料，并进行系统发育和耐药相关性状的分子表征。在2011年至2013年期间，从10名6周至24岁患者的无菌和非无菌部位回收了CRE分离株。合并症包括血液学、遗传学和泌尿系统异常。2例患者在CRE恢复前曾出国旅行（印度、黎巴嫩）。5例检出碳青霉烯酶决定簇，其中2例肺炎克雷伯菌（ST 258和ST 18）和1例大肠埃希菌（ST 131）检出KPC-3，1例肺炎克雷伯菌检出NDM-1。pneumoniae（ST 37）和1株E. coli（ST 101）分离株。检测到其他耐药决定簇，包括CTX-M-15、SHV-11、TEM-1、CMY-2、CMY-4和CMY-42。4例患者死亡，包括3例CRE菌血症患者中的2例。没有证据表明任何2例病例之间存在流行病学或分子相关性。本报告记录了在美国一个主要大都市地区的儿科三级转诊中心，在一个脆弱的患者群体中出现的高耐药革兰氏阴性病原体。详细了解CRE的分布和传播对于及时发现和遏制这些危险病原体至关重要。
Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are on the rise worldwide but are not well described in pediatric populations. This study characterizes the clinical, phenotypic and genotypic characteristics of CRE infections at a free-standing US children's hospital. CRE were defined as any clinical Enterobacteriaceae isolate non-susceptible to either imipenem or meropenem and resistant to ceftriaxone, cefotaxime and ceftazidime determined by routine antimicrobial susceptibility testing. The modified Hodge test was performed to screen for the production of carbapenemase. Clinical data were reviewed, and molecular characterization of phylogenetic and resistance-associated traits was performed. CRE isolates were recovered from sterile and non-sterile sites in 10 patients, 6 weeks to 24 years of age, between 2011 and 2013. Comorbidities included hematologic, genetic and urologic abnormalities. Two patients had traveled abroad (India, Lebanon) before CRE recovery. Carbapenemase determinants were detected in 5 cases, including KPC-3 in 2 Klebsiella pneumoniae (ST258 and ST18) and 1 Escherichia coli (ST131), and NDM-1 in 1 K. pneumoniae (ST37) and 1 E. coli (ST101) isolate. Additional resistance determinants were detected, including CTX-M-15, SHV-11, TEM-1, CMY-2, CMY-4 and CMY-42. Four patients died, including 2 of 3 patients with CRE bacteremia. There was no evidence of epidemiologic or molecular relatedness between any 2 cases. This report documents the appearance of highly resistant Gram-negative pathogens in a vulnerable patient population at a pediatric tertiary referral center in a major US metropolitan area. Detailed understanding of the distribution and spread of CRE is essential for the timely detection and containment of these perilous pathogens.