Colonization of Neonates with Carbapenemase-Producing Enterobacteriaceae (CPE)

K. Mougkou, A. Michos, K. Spyridopoulou, G.L. Daikos, T. Siahanidou, N. Spyridis, J. Kapetanakis, A. Korkas, M. Anagnostakou, C. Papagaroufalis, G. Baroutis, I. Labadaridis, V. Syriopoulou, T. Zaoutis

30th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2012)
Thessaloniki, Greece, May 8-12, 2012

BACKGROUND: Enterobacteriaceae are among the most common human pathogens causing severe infections such as pneumonia, bacteraemia and meningitis. Escherichia coli and Klebsiella pneumoniae remain the two most frequent causes of Gram - negative blood infections with high mortality rate, especially in neonates. In the past few years, acquired carbapenemases are emerging resistance determinants in Gram - negative bacteria. Carbapenemase – Producing Enterobacteriaceae (CPE) are often resistant to all β - lactam antibiotics and frequently co - resistant to aminoglycosides, trimethoprim/sulfamethoxazole and fluoroquinolones. Carbapenemases have spread in multiple adult hospitals in Greece, where they have attained a high level of endemicity. The proportion of imipenem - resistant Klebsiella pneumoniae increased from less than 1% to 40%, among isolates from Greek adult hospital wards over 10 years, from 2001 to 2011, and to 70% among isolates from Intensive Care Units (ICU). There is rarity of data about the epidemiology of CPE in children worldwide. We aimed to determine the point prevalence of CPE in Neonatal Intensive Care Units (NICU) in the Metropolitan area of Athens.  

METHODS: Study design: Multi-center Point Prevalence. Site: 8 NICUs in 5 public hospitals in Athens, including the 2 largest children’s hospitals. Study Period: November, 2011 through January, 2012. We collected rectal and umbilical swabs from infants in 8 NICUs. The specimens were inoculated on McConkey agar plates containing meropenem (0.5mg/L) and incubated for 48 hours. Enterobacteriaceae were identified to the species level by the API 20E method. All isolates were examined for production of carbapenemases by combined disk synergy test utilizing disks containing meropenem, EDTA and boronic acid. Data collection: Demographic and clinical data were collected by medical record review.  

RESULTS: The colonized neonate was a 5 months old female, preterm, who was transferred from another hospital at the age of 23 days. She had no central venous/urinary catheter and was not on mechanical ventilation.   For all cultured neonates there was agreement in the findings between rectal and umbilical specimens. The point prevalence of neonatal colonization with CPE was 0,6 % (1/157) (95% CI: 0.06, 3.5). Out of 314 samples, only one CPE strain was isolated. This was a Klebsiella pneumoniae producing Verona integron-encoded metallo-beta-lactamase (VIM) carbapenemase, that grew from both the rectal and umbilical specimens from the same neonate.  

CONCLUSIONS: The present study showed a very low prevalence of colonization with CPE in NICU patients. These findings contrast significantly with colonization rates in adults in our area. Factors associated with this phenomenon need to be further determined in order to design interventions to prevent the emergence of CPE in children.