Surveillance of multidrug-resistant bacteria in pediatric and neonatal intensive care units in Rio de Janeiro State, Brazil

Abstract INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.

【引言】多重耐药菌（Multi-drug-resistant bacteria, MDR）监测系统用于明确新生儿与儿童群体中多重耐药菌的流行病学特征。本研究旨在阐明巴西里约热内卢州内，多重耐药菌在新生儿重症监护病房（Neonatal Intensive Care Unit, NICU）及儿童重症监护病房（Pediatric Intensive Care Unit, PICU）患者中的定植与感染模式。
【研究方法】本研究采用上报至巴西里约热内卢州多重耐药菌监测系统的新生儿及儿童重症监护病房患者电子数据开展横断面调查。研究纳入研究周期内上报过至少1例病例的所有医疗卫生机构。
【研究结果】2014至2017年间，共上报10210例多重耐药菌病例，其中定植病例9261例，感染病例949例。定植病例中，5379例发生于新生儿重症监护病房，3882例发生于儿童重症监护病房；感染病例中，新生儿重症监护病房内405例，儿童重症监护病房内544例。产超广谱β-内酰胺酶（Extended-spectrum beta-lactamases, ESBL）克雷伯菌属（Klebsiella sp.）与大肠埃希菌（Escherichia coli, E. coli）是新生儿重症监护病房（1983/5379，36.9%）及儿童重症监护病房（1494/3882，38.5%）最常见的定植致病菌。新生儿重症监护病房内导管相关血流感染（Catheter-associated bloodstream infection, CLABSI）、呼吸机相关性肺炎及导管相关尿路感染的主要致病菌分别为克雷伯菌属与大肠埃希菌（56/156，35.9%）、碳青霉烯类耐药革兰阴性菌（Carbapenem-resistant Gram-negative bacteria, CRGNB，22/65，33.9%）以及碳青霉烯类耐药革兰阴性菌（11/36，30.6%）；而儿童重症监护病房内对应感染的主要致病菌分别为耐甲氧西林金黄色葡萄球菌（Methicillin-resistant Staphylococcus aureus, MRSA，53/169，31.4%）、碳青霉烯类耐药革兰阴性菌（50/87，57.4%）以及克雷伯菌属与大肠埃希菌（18/52，34.6%）。
【结论】上报至里约热内卢州多重耐药菌监测系统的病例中，多重耐药革兰阴性菌（产超广谱β-内酰胺酶菌与碳青霉烯类耐药菌）为最常见的致病菌。除儿童导管相关血流感染外，此类致病菌引发了新生儿及儿童重症监护病房内所有的器械相关感染。