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. 2023 Aug 7;8(8):402.
doi: 10.3390/tropicalmed8080402.

Endogenous Bacteremia Caused by Intestinal Colonization of Carbapenem-Resistant Enterobacteriaceae (CR E) in Immunocompromised Children

Nasim Almasian Tehrani  1   2 , Leila Azimi  1 , Shahnaz Armin  1 , Neda Soleimani  2 , Fatemeh Fallah  1 , Abdollah Karimi  1 , Bibi Shahin Shamsian  3 , Shiva Nazari  1 , Masoud Alebouyeh  1
Affiliations

Endogenous Bacteremia Caused by Intestinal Colonization of Carbapenem-Resistant Enterobacteriaceae (CR E) in Immunocompromised Children

Nasim Almasian Tehrani et al. Trop Med Infect Dis. .

Abstract

Objective: Carbapenem-resistant Enterobacteriaceae (CRE) infection is life-threatening, especially for immunocompromised children. The source tracking of CRE could prevent bacteremia during hospitalization. In this study, the intestinal colonization of CRE and their translocation to blood were investigated.

Methods: Stool samples from immunocompromised pediatric patients were collected after admission, and secondary stool and blood samples were collected in case of fever. After CRE phonotypic detection, the OXA-48, NDM-1, VIM, IMP, and KPC genes were detected by PCR. Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) was used to determine the phylogenic relatedness of the blood and fecal isolates.

Results: Bacteremia was recorded in 71.4% of the patients. Enterobacteriaceae spp. were recorded in 100% of the stool samples and 31% of the blood samples. The correlation between the length of stay (LOS), days of fever, chemotherapy regimens, and death rate was significant (p-value ≤ 0.05). OXA-48 was present in all CRE isolates in both the primary and the secondary stool samples and the blood samples. According to the phylogenetic data, 58.33% of the patients with bacteremia had identical blood and stool isolates. The death rate was 24.4% in children with CRE bacteremia.

Conclusions: The primary intestinal colonization with CRE in immunocompromised pediatrics and their translocation to blood was established in this study. The implementation of infection control programs and the application of infection prevention strategies for immunocompromised children is necessary.

Keywords: antimicrobial resistance; bacteremia; carbapenem-resistant Enterobacteriaceae; children; endogenous infection.

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Conflict of interest statement

The authors have no relevant financial or non-financial interest to disclose.

Figures

Figure 1
Figure 1
ERIC-PCR products and dendrogram of CRE strains isolated from primary and secondary fecal and blood samples of children in oncology and transplantation units. Legend. The scale bar represents the similarity coefficient and distance among the strains.
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