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New report identifies antimicrobial resistance patterns in children

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December 28, 2017

A recent analysis of more than 20,000 health care-associated infections among children in the United States highlights antimicrobial resistance patterns that researchers said can be used to help inform infection control and stewardship efforts.

“This report is the first pediatric-specific description of antimicrobial resistance data reported to the [National Health Care Safety Network (NHSN)], and it addresses a critical need for the pediatric infectious disease and infection control communities,” Jason G. Lake, MD, MPH, Epidemic Intelligence Service officer in the CDC’s Division of Healthcare Quality Promotion, and colleagues wrote in Infection Control and Hospital Epidemiology.

Although pediatric patients are particularly vulnerable to the consequences of antimicrobial resistance, evidence of the prevalence of resistant pathogens among children in health care settings is lacking, with most studies being conducted at single institutions, according to the researchers. Therefore, Lake and colleagues examined data from more than 1,000 U.S. hospitals to better under the distribution of antimicrobial-resistant pathogens among children with health care-associated infections (HAIs), specifically central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP) and surgical site infections (SSIs).

From 2011 to 2014, the researchers identified 20,390 HAIs, most of which were CLABSIs (69%), as well as 22,323 pathogens, more than 60% of which included Staphylococcus aureus (17%), coagulase-negative staphylococci (17%), Escherichia coli (11%), Klebsiella pneumoniae and/or oxytoca (9%) and Enterococcus faecalis (8%). 

Among patients with CLABIs, resistance was typically lower in NICUs and highest in oncology wards, where fluconazole resistance reached 40.9% for certain Candida species. Meanwhile, resistance among E. faecium isolates ranged from 66.7% to 85.3% for ampicillin and 53.2% to 60.5% for vancomycin in PICUs, oncology wards and pediatric wards.

For CAUTIs, resistance was higher in pediatric wards, where 12.5% of Pseudomonas aeruginosa isolates were resistant to carbapenems vs. 7.2% in PICUs, and where 15.2% of E. faecalis isolates were resistant to vancomycin vs. 1% in PICUs.

For VAP, resistance among K. pneumoniae/oxytoca and P. aeruginosa isolates was higher in PICUs vs. NICUs. For example, carbapenem resistance was identified in 12.5% of K. pneumoniae/oxytoca isolates in PICUs vs. 1.9% in NICUs, and in 16.3% of P. aeruginosa isolates in PICUs vs. 13.4% in NICUs.

Patterns of antimicrobial resistance among SSIs were similar across procedure types, which included abdominal, orthopedic and neurological surgeries. Resistance to extended-spectrum cephalosporins was high among Enterobacter species (22.2%-35.3%), and MRSA prevalence ranged from 26.2% to 30.5%.

“The differences in antimicrobial resistance seen in this report may indicate priority areas for prevention work,” Lake and colleagues concluded. “Overall, lower antimicrobial resistance rates for most pediatric HAIs compared to previously published data on adult HAIs highlight the opportunity for the pediatric health care community to pursue novel policies and practices to protect their patients from the acquisition and transmission of highly resistant organisms while these events remain uncommon.” ­– ­by Stephanie Viguers

Disclosures: The authors report no relevant financial disclosures.

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