Fecal Carriage and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae from Inpatient Children in a Pediatric Hospital of Shanghai

Figures & data

Figure 1 Distribution of CRE strains in different departments.

Abbreviations: PICU, pediatric intensive care unit; NICU, neonatal intensive care unit.

Table 1 The Clinical Characteristics of CRE Carriers

Characteristics	Total (n=90)	E. aerogenes Carriers (n=30)	K. pneumoniae carriers (n=25)	E. coli Carriers (n=23)	P-value*
Age(m)^a	2(0.7–12)	0.9(0.4–1)	16(5–60)	3(0.7–12.5)	0.000
Male gender	58(64.4%)	16(53.3%)	17(68.0%)	15(65.2%)	0.490
Length of stay (d)^a	31(16–74)	30(15–74)	35(25–77)	25(9–77)	0.012
Length from admission to CRE detected(d)^a	12(3–34)	15(3–32)	8(3–48)	9(3–26)	0.075
Underlying Condition
Gastrointestinal Diseases	20(22.2%)	5(16.7%)	6(24.0%)	5(21.7%)	0.787
Immunocompromised	11(12.2%)	3(10.0%)	4(16.0%)	2(8.7%)	0.691
NRDS	7(12.2%)	1(3.3%)	2(8.0%)	3(13.0%)	0.420
CHD	4(4.4%)	1(3.3%)	0(0.0%)	1(4.3%)	0.600
Invasive Procedures b
Intubation/Mechanical ventilate	52(57.8%)	21(70.0%)	11(44.0%)	16(69.6%)	0.112
Lumbar puncture	34(37.8%)	14(46.7%)	9(36.0%)	8(34.8%)	0.612
Central venous catheter	27(30.0%)	11(36.7%)	5(20.0%)	9(39.1%)	0.363
Surgery	6(6.7%)	3(10.0%)	1(4.0%)	1(4.3%)	0.592
Urinary catheterization	5(5.4%)	2(6.7%)	2(8.0%)	1(4.3%)	0.873
Abdominal drainage	2(2.2%)	0(0.0%)	1(4.0%)	0(0.0%)	0.342
Antibiotic Exposures c
β-lactam/β-lactamase inhibitor	47(52.2%)	13(43.3%)	10(40.0%)	8(34.8%)	0.809
Cephalosporins	32(35.6%)	11(36.7%)	9(36.0%)	9(39.1%)	0.973
Carbapenems	15(16.7%)	5(16.7%)	6(24.0%)	2(8.7%)	0.364
Fluoroquinolones	6(6.7%)	4(13.3%)	2(8.0%)	0(0.0%)	0.195
Vancomycin	6(6.7%)	0(0.0%)	4(16.0%)	1(4.3%)	0.049
Fosfomycin	5(5.6%)	2(6.7%)	3(12.0%)	0(0.0%)	0.237
Outcome
Cure	73(81.1%)	25(83.3%)	18(72.0%)	20(87.0%)	0.381
Death	6(6.7%)	3(10.0%)	3(12.0%)	0(0.0%)	0.247

Notes: ^a Median and interquartile ranges (25th and 75th percentile); ^b Invasive testing or treatment before CRE detected; ^c At least 1 antibiotic dose used before CRE detected. * A comparison between three groups. A P-value of <0.05 was considered statistically significant. The P-value (sig) of age between E. aerogenes and K. pneumoniae carriers, E. aerogenes and E. coli carriers, K. pneumoniae and E. coli carriers were 0.000, 0.006, and 0.018, respectively. The P-value (sig) of Length of stay between E. aerogenes and K. pneumoniae carriers, E. aerogenes and E. coli carriers, K. pneumoniae and E. coli carriers were 0.019, 0.800, and 0.028, respectively.

Abbreviations: m, month; d, day; PICU, pediatric intensive care unit; NICU, neonatal intensive care unit; NRDS, neonatal respiratory distress syndrome; CHD, Chronic Heart Disease.

Table 2 The Clinical Characteristics of CRE Carriers in NICU

Characteristics	Total (n=41)	E. aerogenes Carriers (n=25)	E. coli Carriers (n=10)	P-value
Birth weight (g)^d	1590(1260–1822)	1630(1172–1985)	1360(1260–1590)	0.002
Gestational age (w)	31(30–33)	31(30–34)	31(29–32)	0.003
Apgar score at 5 minutes^d	8(5–9)	8(5–9)	8(6.5–9)	0.624
Feeding options
Breast feeding	28(68.3%)	12(48.0%)	5(50.0%)	1.000
Mixed feeding	8(19.5%)	5(20.0%)	2(20.0%)	1.000
Not started to feed	5(12.2%)	2(8.0%)	2(20.0%)	0.674
Disease during pregnancy
Pre-eclampsia	10(24.4%)	6(24.0%)	3(30.0%)	1.000
Gestational diabetes	9(22.0%)	7(28.0%)	2(20.0%)	0.951
PROM	4(9.8%)	1(4.0%)	2(20.0%)	0.390
Hypothyroidism	2(4.9%)	1(4.0%)	1(10.0%)	1.000
Drug use during pregnancy
Dexamethasone	8(19.5%)	4(16.0%)	2(20.0%)	1.000
Antihypertensives	5(12.2%)	3(12.0%)	2(20.0%)	0.939
Antibiotics	4(9.8%)	3(12.0%)	0(0.0%)	0.633
Insulin	3(7.3%)	2(8.0%)	1(10.0%)	1.000
Euthyrox	2(4.9%)	1(4.0%)	1(10.0%)	1.000
Others	7(17.1%)	5(20.0%)	2(20.0%)	1.000
Delivery method
Cesarean delivery	25(61.0%)	15(60.0%)	6(60.0%)	1.000
Natural vaginal delivery	15(36.6%)	9(36.0%)	4(40.0%)	1.000

Notes: ^dMedian and interquartile ranges (25th and 75th percentile); A P-value of <0.05 was considered statistically significant.

Abbreviations: w, week; PROM: premature rupture of membranes.

Table 3 Antimicrobial Susceptibility and MIC Distributions of CRE Isolates

Antibiotics	Total(n=90)			MBL-producers(n=70)			KPC-2 -producers(n=12)
	MIC50	MIC90	R (%)	MIC50	MIC90	R (%)	MIC50	MIC90	R (%)
	(μg/mL)	(μg/mL)		(μg/mL)	(μg/mL)		(μg/mL)	(μg/mL)
CAZ	>256	>256	100.0	>256	>256	100.0	>256	>256	100.0
CTX	>128	>128	100.0	>128	>128	100.0	>128	>128	100.0
FEP	>256	>256	98.9	>256	>256	100.0	128	>256	100.0
ETP	32	>128	100.0	16	128	100.0	64	>128	100.0
IPM	32	128	97.8	32	128	97.1	32	128	100.0
MEM	32	128	98.9	32	128	100.0	64	256	100.0
CSL	>256	>256	98.9	>256	>256	100.0	>256	>256	100.0
TZP	>256/4	>256/4	98.9	>256/4	>256/4	100.0	>256/4	>256/4	100.0
CIP	8	64	93.3	4	64	94.3	64	128	100.0
SXT	16/304	>32/608	53.3	2/38	16/304	50.0	16/304	>32/608	66.7
AMK	<2	>256	25.6	<2	>256	15.7	>256	>256	83.3
GEN	<1	>128	40.0	<1	>128	31.4	>128	>128	91.7
ATM	128	>256	88.9	128	>256	85.7	128	>256	100.0
CZA	64/4	>128/4	82.2	64/4	>128/4	92.9	2/4	>128/4	33.3
FOS	32	>512	22.2	32	>512	18.6	64	>512	33.3
COL	1	>4	26.7	1	>4	25.7	2	>4	33.3
TGC	1	1	1.1	1	1	1.4	1	1	0.0

Abbreviations: CAZ, ceftazidime; CTX, cefotaxime; FEP, cefepime; ETP, ertapenem; IPM, imipenem; MEM, meropenem; CSL, cefoperazone-Sulbactam; TZP, piperacillin–tazobactam; CIP, ciprofloxacin; SXT, trimethoprim-sulfamethoxazole; AMK, amikacin; GEN, gentamicin; ATM, aztreonam; CZA, ceftazidime-avibactam; FOS, fosfomycin; COL, colistin; TGC, tigecycline; R, resistant.

Figure 2 Dendrogram obtained from ERIC-PCR fingerprinting and Plasmid Replicon Profile of E. aerogenes (A), K. pneumoniae (B) and E. coli (C) isolates.