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A New Metric of Antibiotic Class Resistance in Gram-Negative Bacilli Isolated from Hospitalized Children

  • Sameer J. Patel (a1), Dana O'Toole (a1) and Elaine Larson (a2)

Abstract

Objective.

The purpose of this study was to describe patterns of infection or colonization with antibiotic-resistant gram-negative bacilli (GNB) in hospitalized children utilizing an electronic health record.

Setting.

Tertiary care facility.

Participants.

Pediatric patients 18 years of age or younger hospitalized from January 1, 2006, to December 31, 2008.

Methods.

Children were identified who had (1) at least 1 positive culture for a multidrug-resistant (MDR) GNB, defined as a GNB with resistance to 3 or more antibiotic classes; or (2) additive drug resistance, defined as isolation of more than 1 GNB that collectively as a group demonstrated resistance to 3 or more antibiotic classes over the study period. Differences in clinical characteristics between the 2 groups were ascertained, including history of admissions and transfers, comorbid conditions, receipt of procedures, and antibiotic exposure.

Results.

Of 56,235 pediatric patients, 46 children were infected or colonized with an MDR GNB, of which 16 were resistant to 3 classes and 30 were resistant to 4 classes. Another 39 patients had positive cultures for GNB that exhibited additive drug resistance. Patients with additive drug resistance were more likely than patients with MDR GNB to have had previous admissions to a long-term facility (8 vs 2; P = .04) and had more mean admissions (7 vs 3; P <.01) and more mean antibiotic-days (P < .01 to P = .02). Six patients with additive drug resistance later had a positive culture with an MDR GNB.

Conclusions.

An electronic health record can be used to track antibiotic class resistance in GNB isolated from hospitalized children over multiple cultures and hospitalizations.

Copyright

Corresponding author

Department of Pediatrics, Division of Pediatric Infectious Diseases, Columbia University, 622 West 168th Street, PH 4W-475, New York, NY 10032 (sp2172@columbia.edu)

References

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1. Kallen, AJ, Hidron, AI, Patel, J, Srinivasan, A. Multidrug resistance among gram-negative pathogens that caused healthcare-associated infections reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol 2010;31: 528531.
2. Falagas, ME, Karageorgopoulos, DE. Pandrug resistance (PDR), extensive drug resistance (XDR), and multidrug resistance (MDR) among gram-negative bacilli: need for international harmonization in terminology. Clin Infect Dis 2008;46:11211122.
3. Lidsky, K, Hoyen, C, Salvator, A, Rice, LB, Toltzis, P. Antibiotic-resistant gram-negative organisms in pediatric chronic-care facilities. Clin Infect Dis 2002;34:760766.
4. Zaoutis, TE, Goyal, M, Chu, JH, et al. Risk factors for and outcomes of bloodstream infection caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in children. Pediatrics 2005;115:942949.
5. Kim, YK, Pai, H, Lee, HJ, et al. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:14811491.
6. Abdel-Hady, H, Hawas, S, El-Daker, M, El-Kady, R. Extended-spectrum beta-lactamase producing Klebsiella pneumoniae in neonatal intensive care unit. J Perinatol 2008;28:685690.
7. Arnoni, MV, Berezin, EN, Martino, MD. Risk factors for nosocomial bloodstream infection caused by multidrug resistant gram-negative bacilli in pediatrics. Braz J Infect Dis 2007;11: 267271.
8. Furuya, EY, Lowy, FD. Antimicrobial-resistant bacteria in the community setting. Nat Rev Microbiol 2006;4:3645.
9. Mandar, A, Neideil, M, Yoko Furuya, E, Caplan, D, Glied, S, Larson, E. Using electronically available inpatient hospital data for research. Clin Translational Sci J 2011;4:338345.
10. Clinical and Laboratory Standards Institute (CLSI). Cephalosporin and Aztreonam Breakpoint Revisions Fact Sheet. Wayne, PA: CLSI, 2010. CLSI document M100-S20. http://www.clsi.org/Content/NavigationMenu/Committees/Microbiology/AST/CephalosporinandAztreonamBreakpointRevisionFactSheet/CephalosporinAztreonamBreakpointFactSheet.pdf. Accessed September 15, 2011.
11. Samra, Z, Ofir, O, Lishtzinsky, Y, Madar-Shapiro, L, Bishara, J. Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents 2007;30:525529.
12. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256260.
13. Huang, SS, Yokoe, DS, Stelling, J, et al. Automated detection of infectious disease outbreaks in hospitals: a retrospective cohort study. PLoS Med 2010;7:e1000238.
14. Morgan, DJ, Day, HR, Furuno, JP, et al. Improving efficiency in active surveillance for methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at hospital admission. Infect Control Hosp Epidemiol 2010;31:12301235.
15. Bertrand, X, Thouverez, M, Talon, D, et al. Endemicity, molecular diversity and colonisation routes of Pseudomonas aeruginosa in intensive care units. Intens Care Med 2001;27:12631268.
16. Harris, AD, Perencevich, EN, Johnson, JK, et al. Patient-to-patient transmission is important in extended-spectrum beta-lactamase-producing Klebsiella pneumoniae acquisition. Clin Infect Dis 2007;45:13471350.
17. Harris, AD, Kotetishvili, M, Shurland, S, et al. How important is patient-to-patient transmission in extended-spectrum beta-lactamase Escherichia coli acquisition. Am J Infect Control 2007; 35:97101.
18. Manikal, VM, Landman, D, Saurina, G, Oydna, E, Lai, H, Quale, J. Endemie carbapenem-resistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin Infect Dis 2000;31:101106.
19. Lopushinsky, SR, Covarrubia, KA, Rabeneck, L, Austin, PC, Urbach, DR. Accuracy of administrative health data for the diagnosis of upper gastrointestinal diseases. Surg Endose 2007;21: 17331737.

A New Metric of Antibiotic Class Resistance in Gram-Negative Bacilli Isolated from Hospitalized Children

  • Sameer J. Patel (a1), Dana O'Toole (a1) and Elaine Larson (a2)

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