Analysis of Cases of Multidrug-Resistant Klebsiella Pneumoniae Infection in Children with Congenital Heart Defects

Olena O. Yakimishen; Serhii M. Boyko; Tetiana A. Malysheva; Anna P. Goidra; Iaroslav P. Truba

doi:10.30702/jcvs/22.30(01)/YaB006-2126

Olena O. Yakimishen National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-0634-3579
Serhii M. Boyko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-6223-1918
Tetiana A. Malysheva National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-5900-2447
Anna P. Goidra National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-4242-5173
Iaroslav P. Truba National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-5214-408X

DOI: https://doi.org/10.30702/jcvs/22.30(01)/YaB006-2126

Keywords: K. pneumoniae, hospital infections, antibiotic resistance, carbapenem-resistant strains, extended-spectrum β-lactamases, ceftazidime/avibactam

Abstract

Background. Klebsiella pneumoniae (K. pneumoniae) is one of the main causes of hospital infections (pneumonia, urinary tract infections, blood infections) in children with congenital heart disease in the intensive care unit. Multidrugresistant strains significantly complicate and treatment, but with rational antibiotic therapy it is possible to achieve effective treatment results.

The aim. To analyze the detection of different strains of K. pneumoniae in children with congenital heart disease in the intensive care unit and the principles of antibiotic therapy in the treatment of infections caused by them.

Materials and methods. At the Department Of Congenital Heart Disease Surgery for Newborns and Young Children, of the National Amosov Institute of Cardiovascular Surgery we examined 2548 patients in 2018-2020. Microbiological examination was performed in 370 children. Bacteriological culturing (sputum, blood) of the studied material on special medium for bacterial growth was analyzed on VITEK-2 analyzer for 72 hours. If a progenitor was seen, the sample was considered as positive, and the resulting columns were tested for sensitivity to antibiotics.

Results. The bacterial growth was positive in 277 (75%) children, of whom K. pneumoniae was found in 98 (25%) patients in 138 tests. We obtained the following data: K. pneumoniae in 79 (57%) patients, extended spectrum betalactamase (ESBL)-producing K. pneumoniae in 47 (34%), carbapenem-resistant K. pneumoniae in 11 (8%), multiresistant K. pneumoniae in 1 (1%) patient. We prescribed standard or specific therapy in accordance with the recommendations for the treatment of infections caused by K. pneumoniae and its susceptibility to the antibiotics.

Conclusions. It is important to follow the rules of rational antibiotic therapy (taking into account the sensitivity of the stimuli, pharmacodynamic and pharmacokinetic properties of the drugs) when treating infections. The spread of carbapenem-resistant strains of microorganisms leads to the loss of the possibility of using carbapenems as a reserve antibiotic, which significantly complicates the treatment of infections, and ceftazidime/avibactam should be the drug of choice in wards where the number of carbapenem-resistant strains equals to/exceeds 20%.

References

Krajewska J, Laudy AE. The European medicines agency approved the new antibacterial drugs – response to the 2017 who report on the global problem of multi-drug resistance. Postępy Mikrobiologii - Advancements of Micro-biology. 2021;60(4):249-64. https://doi.org/10.21307/PM-2021.60.4.20
Ovrutskiy S, Rehm K, Weber S, Nordmeyer S, Miera O, Photiadis J, Berger F. Colonization with Multiresistant Gram-Negative (MRGN) Bacteria in Paediatric Cardiovascular Surgery: Is It An Additional Risk Factor for Postoperative Morbidity? Thorac Cardiovasc Surg. 2016;64:ePP66. https://doi.org/10.1055/s-0036-1571932
Mendelson M, Matsoso MP. The World Health Organization global action plan for antimicrobial resistance. S Afr Med J. 2015;105(5):325. https://doi.org/10.7196/samj.9644
On the approval of the National Action Plan FOR COM-BATING Antimicrobial Resistance Order of March 6, 2019, No. 116-p. Available from: https://zakon.rada.gov.ua/go/116-2019-%D1%80
Baek EH, Kim SE, Kim S, Lee S, Cho OH, In Hong S, Shin JH, Hwang I. Successful control of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae ST307 outbreak in a neonatal intensive care unit. BMC Infect Dis. 2020;20(1):166. https://doi.org/10.1186/s12879-020-4889-z
Caselli E, D’Accolti M, Soffritti I, Piffanelli M, Mazzacane S. Spread of mcr-1-Driven Colistin Resistance on Hospital Surfaces, Italy. Emerg Infect Dis. 2018;24(9):1752-3. https://doi.org/10.3201/eid2409.171386
Canver MC, Satlin MJ, Westblade LF, Kreiswirth BN, Chen L, Robertson A, Fauntleroy K, La Spina M, Callan K, Jenkins SG. Activity of Imipenem-Relebactam and Comparator Agents against Genetically Characterized Isolates of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2019;63(9):e00672-19. https://doi.org/10.1128/AAC.00672-19
Sader HS, Castanheira M, Streit JM, Carvalhaes CG, Mendes RE. Frequency and antimicrobial susceptibility of bacteria causing bloodstream infections in pediatric patients from United States (US) medical centers (2014–2018): Therapeutic options for multidrug-resistant bacteria. Diagn Microbiol Infect Dis. 2020;98(2):115108. https://doi.org/10.1016/j.diagmicrobio.2020.115108