Summary
Background
Nosocomial infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB)
are associated with increased mortality and prolonged hospitalization; thus, later
CRGNB decolonization has significant clinical and public health implications.
Aim
To investigate modifiable/non-modifiable risk factors for CRGNB later gut decolonization
in children.
Methods
CRGNB carriers (aged from one day to 16 years) hospitalized in a tertiary level hospital
(2018–2019) were included. Upon CRGNB carriage detection, rectal swab cultures were
taken weekly, if patients were hospitalized, and monthly after discharge for 12 months.
CRGNB decolonization was defined as three consecutive negative rectal-swab cultures
obtained ≥1 week apart. Modifiable (treatment administered/medical devices) and non-modifiable
(age/gender/comorbidities) risk factors were recorded. Cox regression for later CRGNB
decolonization was performed.
Findings
One hundred and thirty CRGNB carriers were recorded. After 12 months, 5.4% remained
carriers. Risk factors for later decolonization were immunosuppression (hazard ratio:
0.52; 95% confidence interval: 0.31–0.87), carbapenems (0.52; 0.30–0.91), proton pump
inhibitors (PPIs) (0.39; 0.24–0.64) and their duration of use, duration of hospitalization
(0.90; 0.81–0.92, per 10 days), number of readmissions (0.90; 0.86–0.96), abdominal
surgery (0.33; 0.17–0.65), urinary catheter (0.42; 0.24–0.76), and duration of steroid
administration per 10 days (0.86; 0.84–0.88).
Conclusions
Carbapenems, PPIs and their duration of use, duration of steroids use, immunosuppression,
urinary catheter, readmissions, duration of hospitalization, and abdominal surgery
are associated with later CRGNB decolonization among children. Paediatric patients
at risk of later decolonization should be under targeted screening and pre-emptive
contact precautions. Known carriers at risk of later CRGNB decolonization should be
under meticulously applied contact precautions for longer durations.
Keywords
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Article info
Publication history
Published online: April 17, 2023
Accepted:
March 28,
2023
Received:
December 29,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
