Suspicion of respiratory tract infection with multidrug-resistant Enterobacteriaceae: epidemiology and risk factors from a Paediatric Intensive Care Unit

BMC Infectious Diseases

Research Article

Michael Hofbeck¹  Felix Neunhoeffer¹  Hanna Renk¹  Lenja Stoll¹  Matthias Kumpf¹  Dominik Hartl²  Florian Hölzl³ 

[1] Dept. of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, 72076, Tübingen, Germany;Dept. of Paediatrics, Pediatric Infectious Diseases, Immunology & Pneumology/Cystic fibrosis, University Children’s Hospital Tübingen, Hoppe-Seyler Str. 1, 72076, Tübingen, Germany;Institute of Medical Microbiology and Hygiene, University of Tübingen, Elfriede-Aulhorn-Str.6, 72076, Tübingen, Germany;

关键词: Paediatric Intensive Care Unit;    Multivariable Logistic Regression Model;    Antibiotic Exposure;    Tracheal Aspirate;    Paediatric Intensive Care Unit Stay;   

DOI  :  10.1186/s12879-017-2251-x

 received in 2016-05-12, accepted in 2017-02-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMultidrug-resistant (MDR) infections are a serious concern for children admitted to the Paediatric Intensive Care Unit (PICU). Tracheal colonization with MDR Enterobacteriaceae predisposes to respiratory infection, but underlying risk factors are poorly understood. This study aims to determine the incidence of children with suspected infection during mechanical ventilation and analyses risk factors for the finding of MDR Enterobacteriaceae in tracheal aspirates.MethodsA retrospective single-centre analysis of Enterobacteriaceae isolates from the lower respiratory tract of ventilated PICU patients from 2005 to 2014 was performed. Resistance status was determined and clinical records were reviewed for potential risk factors. A classification and regression tree (CRT) to predict risk factors for infection with MDR Enterobacteriaceae was employed. The model was validated by simple and multivariable logistic regression.ResultsOne hundred sixty-seven Enterobacteriaceae isolates in 123 children were identified. The most frequent isolates were Enterobacter spp., Klebsiella spp. and E.coli. Among these, 116 (69%) isolates were susceptible and 51 (31%) were MDR. In the CRT analysis, antibiotic exposure for ≥ 7 days and presence of gastrointestinal comorbidity were the most relevant predictors for an MDR isolate. Antibiotic exposure for ≥ 7 days was confirmed as a significant risk factor for infection with MDR Enterobacteriaceae by a multivariable logistic regression model.ConclusionsThis study shows that critically-ill children with tracheal Enterobacteriaceae infection are at risk of carrying MDR isolates. Prior use of antibiotics for ≥ 7 days significantly increased the risk of finding MDR organisms in ventilated PICU patients with suspected infection. Our results imply that early identification of patients at risk, rapid microbiological diagnostics and tailored antibiotic therapy are essential to improve management of critically ill children infected with Enterobacteriaceae.

【 授权许可】

CC BY   
© The Author(s). 2017