Carbapenem-resistant Klebsiella pneumoniae (CRKp) in Children. Clinical and Epidemiological Characteristics from Infected and Colonized Inpatients in a Tertiary care Hospital in Medellín, Colombia
Carbapenem-resistant Klebsiella pneumoniae (CRKp) in Children. Clinical and Epidemiological Characteristics from Infected and Colonized Inpatients in a Tertiary care Hospital in Medellín, Colombia.
Alejandro Diaz, MD1, Andrea Restrepo, MD2, Diana Ortiz, MD3, Mónica Trujillo, MD, MSSc2, Carlos Garcés, MD2 and Fabián Jaimes, MD, PhD2, (1) Universidad CES, Medellín, Colombia, (2) Hospital Pablo Tobón Uribe, Medellín, Colombia, (3) Universidad CES, Medellín, Colombia.
Background: Multidrug resistant Gram-negative infections represent a growing problem and a serious global threat. Data in children is scarce. K. pneumoniae carbapenemases (KPC) are the most common mechanism of resistance this bacteria have developed. We report the clinical characteristics and outcomes from a cohort of children infected or colonized with carbapenem-resistant K.pneumoniae at Hospital Pablo Tobón Uribe in Medellín, Colombia. A KPC-2 producing K. pneumoniae outbreak started in our institution in 2008. Despite the implementation of several control measures including strict contact isolation, patient cohorting and routine surveillance cultures, the outbreak spread from adult to pediatric wards.
Methods: We performed a retrospective chart review of all pediatric cases in whom CRKp were identified from 2008 to 2013. Clinical and demographic characteristics and outcomes were recorded.
Results: A total of 34 infected children (median age 22,8 months) with 43 episodes (1 had two episodes, 2 patients had three and one with 5) and 55 colonized patients (median age 33 months) were identified. Demographic and clinical characteristics from infected and colonized patients are shown in table 1. Urinary tract and intra-abdominal infections were the most common type of infections (Figure 1). Antimicrobial therapy and outcomes from infected patients are presented on table 2. Severely ill children received combined antimicrobial therapy. Mortality was lower with meropenem containing regimens (p = 0,03).
Conclusion: CRKp infections occur more frequently in children with comorbidities, prolonged hospital stays and prior antibiotic exposure. Mortality is high. A meropenem containing regimen seems to be the best choice in severely ill children.
D. Ortiz, None
M. Trujillo, None
C. Garcés, None
F. Jaimes, None
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