Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Hospitalized Children

Background: Carbapenem-resistant Gram-negative pathogens (CRPs) are emerging as major causes of nosocomial infections that increase morbidity, mortality and healthcare costs. Little is known about CRP infections in children. Methods: All newly detected infections caused by carbapenem-resistant Klebsiella spp, Pseudomonas spp or Acinetabocater spp in hospitalized patients are prospectively reported to the Hellenic Center for Disease Control and Prevention. All children <15 years old with a CRP infection reported from November 1, 2010, through March 30, 2012, were included in this study. Results: Between November 2010 and March 2012, 71 CRP infections in 65 children (median age: 1 year) were reported. Underlying conditions existed in 50 (76.9%) children. Cases included pneumonia (25 [35.2%], including 20 ventilator-associated pneumonias), bacteremia (32.4%), urinary tract infection (19.7%) and surgical site infection (12.7%). Isolates were Pseudomonas spp (41.1%), Acinetobacter spp (39.7%) and Klebsiella spp (19.2%). The first positive culture occurred a median of 20 days (range: 0-313 days) after admission. Twenty-four (33.8%) infections occurred in patients with a history of hospitalization the previous 6 months; 42 (59.2%) and 36 (50.7%) infections occurred among patients who had received broad-spectrum antibiotics including carbapenems the previous 6 months, respectively. The crude mortality at 28 days after the first positive CRP culture was 21.1%. Conclusions: Infections caused by CRPs among children are associated with significant morbidity and mortality.