Παράγοντες που σχετίζονται με την εξάλειψη του αποικισμού Gram-αρνητικών μικροβίων ανθεκτικών στις καρβαπενέμες σε παιδιά και νεογνά ; Risk factors for late-onset gut decolonization in neonatal and pediatric carbapenem-resistant Gram-negative bacterial carriers

Introduction: Prolonged administration of carbapenems may convert human intestinal tract to a reservoir of resistant bacteria. Although there are a few studies from adults on the rate of spontaneous decolonization and the factors associated with later decolonization, there is a paucity of data in children. However, findings of adult studies may not apply for pediatric patients. Aim: To investigate the phenomenon of spontaneous carbapenem-resistant Gram-negative bacterial (CRGNB) decolonization in neonates and children in terms of: a) risk factors associated with later decolonization b) rate of spontaneous decolonization, c) development of CRGNB- infection between CRGNB-colonized and factors associated with the development of infection, d) laboratory documentation (PCR versus conventional cultures). Method: This was a prospective study, conducted at Hippokration General Hospital, Thessaloniki, Greece. Patients, aged 1 day to 16 years old, hospitalized in the hospital during 2018-2019 and found to be CRGNB-colonized, were included in the study. Rectal swab cultures were taken from all the patients, weekly for as long as they were hospitalized and monthly after discharged, for twelve months. Microbiological eradication defined the presence of at least three consecutive negative rectal swab cultures, spaced at least one week apart. Demographics, clinical characteristics, medication and the use of medical devices were recorded and possible risk factors for prolonged colonization were investigated. The duration of colonization from the first positive culture to microbiological eradication were also recorded, including the development of CRGNB-infection. Patients with a positive rectal culture after three consecutive negative cultures were screened also with PCR analysis for the carbapenemases KPC-1, VIM-1, OXA-48 and NDM-1. Results: One-hundred thirty patients (median age, 1.3 months; Q1-Q3, 0.8-6.9 months) were studied including 66 neonates (median age, 12.6 days; Q1-Q3: 4-17.5 days). Risk factors for later clearance ...