In July 2023, a study led by Professor XiaoFan Zhu from Chinese Academy of Medical Sciences Blood Disease Hospital (Institute of Hematology, Chinese Academy of Medical Sciences) was published in the international academic journal——Antimicrobial Resistance and Infection Control. The title of the study is "High risk of bloodstream infection of carbapenem-resistant enterobacteriaceae carriers in neutropenic children with hematological diseases". The analysis underscores the critical threat posed by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections (BSIs) in neutropenic pediatric hematology patients.Carbapenem-resistant Enterobacteriaceae (CRE) infections represent a critical concern, especially among immunocompromised populations, such as neutropenic pediatric hematology patients. Despite the growing recognition of this issue, research focusing on this specific demographic remains limited. This study addresses this gap by conducting a thorough investigation into the occurrence, attributes, and consequences of CRE bloodstream infections (BSIs) within this vulnerable population. Through a retrospective cohort study spanning twelve years and comprising 2,465 patients, the prevalence of CRE colonization was evaluated via perirectal swabs. The study aimed to delineate risk factors associated with the development of CRE-BSIs and to assess their impact on 30-day mortality rates. Key findings underscore the pronounced risk posed by CRE colonization and emphasize the imperative for tailored antimicrobial interventions informed by the distinctive features of CRE strains.
The emergence of CRE, characterized by its resistance to carbapenem antibiotics, presents a formidable challenge in the management of bacterial infections, particularly in immunocompromised patients undergoing treatment for hematological diseases. Neutropenic pediatric patients, especially those with underlying hematological conditions, face an increased risk of life-threatening BSIs, with CRE posing a significant threat due to its high level of multi-drug resistance. However, existing research on CRE infections in pediatric populations remains limited, underscoring the need for comprehensive studies to address this critical gap in knowledge.
A retrospective cohort study was conducted over a twelve-year period from 2008 to 2020, involving 2,465 neutropenic pediatric patients diagnosed with hematological diseases at a distinguished medical academy in China. The study employed meticulous screening techniques, including routine perirectal swabs, to assess CRE colonization among the participants. Patients who developed CRE-BSIs during the study period were identified, and their clinical profiles were compared with non-colonized individuals who also developed BSIs.
Perirectal swabs were collected and analyzed using standardized laboratory techniques to detect the presence of CRE colonization. Patients were closely monitored for the development of bloodstream infections, and those with confirmed CRE-BSIs were included in the analysis. Survival analysis techniques, including the Kaplan-Meier method and Cox regression models, were employed to identify risk factors associated with CRE-BSI development and assess their impact on 30-day mortality outcomes.
The study revealed a prevalence of CRE colonization in pediatric patients to be 2.39%, with 32.2% of these patients developing CRE-BSIs during the study period. Analysis demonstrated a significantly lower 30-day survival probability among CRE-BSI patients compared to non-infected counterparts. Risk factors associated with reduced 30-day survival included mucosal damage, ICU admission, CRE colonization, and the subsequent development of CRE-BSI.
Independent risk factors for CRE-BSI occurrence included combined antibiotic therapy, prolonged neutropenia, mucosal damage, and ICU admissions. These findings highlight the complex interplay of clinical variables contributing to the development and outcomes of CRE-BSIs in neutropenic pediatric hematology patients.
（Antimicrob Resist Infect Control . 2023 Jul 8;12(1):66.）
The study findings underscore the heightened risk of CRE-BSIs in neutropenic pediatric hematology patients and their significant impact on patient outcomes. Mucosal damage and CRE colonization emerged as significant predictors not only for CRE-BSI development but also for elevated 30-day mortality rates, emphasizing the importance of early detection and targeted interventions in this vulnerable population.
The observed association between ICU admission and increased risk of CRE-BSI underscores the need for enhanced infection control measures and vigilant monitoring in critical care settings. Furthermore, the identification of combined antibiotic therapy and prolonged neutropenia as independent risk factors emphasizes the importance of judicious antimicrobial use and timely management of neutropenic episodes to mitigate the risk of CRE-BSIs.
Despite the robustness of the study design and analysis, several limitations warrant consideration. The retrospective nature of the study may introduce biases associated with data collection and documentation. Additionally, the study was conducted at a single medical academy in China, limiting the generalizability of the findings to broader populations or different healthcare settings. Furthermore, the relatively low prevalence of CRE colonization and BSIs in the study population may have impacted the statistical power to detect significant associations accurately.
In conclusion, CRE-BSIs emerge as critical independent prognosticators of elevated mortality in neutropenic pediatric hematology patients, highlighting the imperative for individualized antimicrobial intervention and proactive precautionary measures in this vulnerable cohort. Future research endeavors should aim to overcome these limitations and further elucidate the dynamics of CRE infections in pediatric populations, informing evidence-based clinical practices and infection control strategies to combat this growing threat effectively.
In summary, this study underscores the critical threat posed by carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections (BSIs) in neutropenic pediatric hematology patients. The findings highlight the significant impact of CRE colonization on 30-day mortality rates and emphasize the urgent need for tailored antimicrobial interventions. Mucosal damage and CRE colonization emerged as key predictors of CRE-BSI development and mortality, emphasizing the importance of proactive screening and individualized treatment strategies. Despite study limitations, these insights inform the imperative for enhanced infection control measures and targeted interventions to combat CRE infections effectively in this vulnerable population.
