Carbapenemase-resistance K. oxytoca (KPC) Bacteremia in Children
Paulina M Zurita, Aarón Espinosa, Javier Ordoñez, Miguel A MineroAbstract
Background
Carbapenemase Klebsiella oxytoca (KPC) is a class A β-lactamase that is capable of hydrolyzing carbapenems. There are limited studies in children about epidemiology, but there are reports about increasing carbapenem-resistant Enterobacteriaceae (CRE) in the pediatric population. Here, we described the clinical and molecular characteristics of four consecutive patients in a tertiary referral hospital in Mexico city.
Methods
We retrospectively reviewed the medical records of patients in the Pediatrics area who developed a cluster of K. oxytoca bacteremia at our institution in February 2024. The identification and the antibiotic susceptibility testing was performed by Vitek 2®. The molecular diagnostic was made by Xpert® Carba-R system. Data collected included patient demographics, clinical presentation, underlying disease, treatment regimens and outcomes.
Results
We identified four cases of carbapenemase-resistance K. oxytoca bacteremia during this study period. The median age of the patients was 11 years (range 9-14 years). The most common clinical presentation was fever (100%). All patients had indwelling medical devices (central venous catheter – 100%) and had received intravenous antibiotics mostly cefalosphorins of forth generation and carbapenems at least one week prior the isolation. The overall mortality rate was 25%. The MICs of both Imipenem and Meropenem were >16 μg/ml. Due to the resistance profile we infered they were carbapenemases producers, so we send them for identification reporting in all KPC carbapenemase producing K. oxytoca. Only 75% of the patients had received ceftazidime/avibactam with an adequate resolution of the blood stream infection.
Conclusions
The rise of CRE in pediatric patients has triggered the implementation of outbreak investigation measures. Treatment of CRE infections in children remains challenging because lack of data of dosing regimens and effectiveness of new antibiotics, so they require an individualized approach. Early diagnosis and appropriate antimicrobial therapy are crucial for improving outcomes.