Epidemiology of Antimicrobial Resistance and Utilization in Children with Central Line Associated Bloodstream Infections (CLABSIS) in Greece

K. Mougkou, S. Kouni, G. Kourlaba, E. Critseli, A. Harisiadou, E. Lebessi, N. Spyridis, M. Theodoridou, S. Coffin, T.E. Zaoutis

31st Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2013)
Milan, Italy, May 28-June 1, 2013

BACKGROUND: Healthcare associated infections are associated with significant morbidity, mortality, and costs worldwide; many are caused by multi-drug resistant organisms (MDROs) which further results in worse outcomes. We examined the prevalence of MDRO pathogens causing CLABSIs and antibiotic utilization.

METHODS: We conducted active surveillance for CLABSIs and antibiotic use in intensive care units, oncology and transplant units at 2 children's hospitals in Greece between September-December 2012. CLABSIs were prospectively identified using CDC definitions. An antibiotic day (AD) was defined as a calendar day in which at least one antimicrobial was given.

RESULTS: 28 CLABSIs were identified from 22 children. Gram negative organisms were most commonly isolated (18, 64.2%): Klebsiella spp. (6, 33.3%), Enterobacter spp. (5, 27.7) and Escherichia coli (4, 22.2%). Resistance to third generation cephalosporins (likely ESBLs) were detected in 66.6% of Klebsiella spp. Carbapenem resistance was noted in 1 isolate of Klebsiella. CLABSIs were also caused by Candida spp (6, 21.4%) and gram-positive organisms 4 (14.2%), including 1 resistant isolate (vancomycin-resistant Enterococcus faecium).  

On surveillance units there were 3423 antibiotic days during 6246 patient days (antibiotic utilization ratio 0.548). Meropenem (39%), amikacin (32%), and teicoplanin (28.5%) were the most frequently used antimicrobials.  

CONCLUSIONS: The majority of pathogens causing CLABSIs in hospitalized children in Greece were MDROs requiring use of broad-spectrum antibiotics. These findings call for rapid and effective adoption of infection control and antimicrobial stewardship strategies to prevent further emergence and spread of MDROs.