March 15, 2017
2 min read

Multidrug resistant gram-negative infections increased 700% among children

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The number of children infected with multidrug resistant gram-negative enteric Enterobacteriaceae increased significantly over the previous 8 years, associated with longer hospital stays and increased mortality risk, according to a recent study.

“There is a clear and alarming upswing throughout this country of antibiotic-resistant Enterobacteriaceae infections in kids and teens,” Sharon B. Meropol, MD, PhD, from the department of pediatrics at Case Western Reserve University, said in a press release. “This makes it harder to effectively treat our patients’ infections. The problem is compounded because there are fewer antibiotics approved for young people than adults to begin with. Health care providers have to make sure we only prescribe antibiotics when they are really needed.”

The researchers noted that although most published studies concerning the epidemiology of multidrug resistant Gram-negative Enterobacteriaceae (MDR-GNE) infections have concentrated on adults, there was insufficient clinical detail among pediatric populations. To assess pediatric MDR-GNE infections, including incidence, risk factors and outcomes, the researchers examined data from 48 children’s hospitals sustained by the Pediatric Hospital Information System.

The proportion of children ages 0 to less than 18 years old who were diagnosed with Enterobacteriaceae-associated infections and had MDR-GNE were described. Researchers also assessed the connection between MDR-GNE, the length of stay for patients and death before discharge. These infections occurred between January 1, 2007 and March 31, 2015.

From the 48 children’s hospitals, 107,610 patients were discharged after being treated for Enterobacteriaceae infections, and 0.7% of these were labeled as MDR-GNE. Instances of multi–drug resistant bacteria increased throughout the study, starting at 0.2% in 2007 to 1.5% in 2015. Nosocomial infections caused 23% of MDR-GNE hospitalizations. Those most at risk for MDR-GNE were those who were older and those with comorbid conditions.

When compared with patients without MDR-GNE, patients with the infection had 20% longer hospital stays. Although hospitalizations were longer for those with this infection, there was no statistical significance for greater chances of death. The results of this study were robust to sensitivity analyses.

We found that older children, children with comorbidities and those in the Western U.S. were more likely to be infected with MDR-GNE, but we found no differences based on sex or insurance coverage,” researchers wrote. “We found inconsistent risks based on race, with lower risks of MDR-GNE for white and black children compared with those of other races and those of mixed race. Reasons underlying these disparities are unknown.” – by Katherine Bortz

Disclosure: This work was supported by the National Institute for Allergy and Infectious Diseases at the National Institutes of Health.