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Carbapenem-resistant Enterobacteriaceae Infections in Children: An Italian Retrospective Multicenter Study

Montagnani, Carlotta MD, PhD; Prato, Manuela MD; Scolfaro, Carlo MD; Colombo, Sara MD; Esposito, Susanna MD; Tagliabue, Claudia MD; Lo Vecchio, Andrea MD, PhD; Bruzzese, Eugenia MD, PhD; Loy, Anna MD; Cursi, Laura MD; Vuerich, Marco MD; de Martino, Maurizio MD; Galli, Luisa MDfor the Italian Society of Pediatric Infectious Diseases

The Pediatric Infectious Disease Journal: August 2016 - Volume 35 - Issue 8 - p 862–868
doi: 10.1097/INF.0000000000001188
Original Studies

Background: The spread of carbapenem-resistant Enterobacteriaceae (CRE) is a health problem of major concern. CRE-related infections have significant morbidity and mortality, but data on CRE infection in pediatric population are limited. The aim of this study was to analyze epidemiologic and clinical characteristics, risk factors, therapeutic options and outcome of CRE infections in children in Italy.

Methods: We performed a retrospective, multicenter, observational study of children with confirmed CRE infection or colonization admitted between January 1, 2011, and March 1, 2014, to 7 Italian pediatric centers.

Results: Sixty-nine patients presenting 74 CRE infections and/or colonization were included. The most frequently isolated strain was Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Children with CRE infections had longer length of stay in hospital (P < 0.001), duration of disease (P = 0.001) and antimicrobial treatment (P < 0.001) than colonized children. Oncologic/immunosuppressive conditions are one of the factors significantly associated with a fatal outcome among children with CRE infections.

Conclusions: Our study confirms that CRE infections affect mostly children with oncologic diseases and immunosuppression. Controlled studies in large cohorts are needed to evaluate the best therapeutic options and to assess further risk factors influencing outcomes and the survival of pediatric patients with infections caused by CRE.

From the *Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, Florence, Italy; Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy; Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; §Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy; Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy; Pediatrics and Infectious Diseases, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy; and **Neonatal Unit, Azienda Ospedaliero-Universitaria pisana, Pisa, Italy.

Accepted for publication March 21, 2016.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Luisa Galli, MD, Department of Health Sciences, University of Florence, Anna Meyer Children’s University Hospital, viale Gaetano Pieraccini 24, I-50139, Florence, Italy. E-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.