Clinical and molecular epidemiologic characteristics of carbapenem-resistant Klebsiella pneumoniae infection/colonization among neonates in China

Background: The spread of carbapenem-resistant Klebsiella pneumoniae (CR-KPN) is a major concern, but data on CR-KPN infection/colonization in paediatric populations are limited. Aim: To analyse epidemiologic and clinical characteristics, and therapeutic options for CR-KPN infections in neonates in China. Methods: A retrospective study was performed at the Children's Hospital of Fudan University, including 88 neonates with CR-KPN admitted between November 2015 and October 2016. Forty-seven CR-KPN isolates were chosen at random for further study, including antimicrobial susceptibility testing, potential beta-lactamase screening and homology analysis. Findings: In total, 44.3% (39/88) of the neonates with CR-KPN were infected, and 71.8% (28/39) were nosocomial infections. Of these, pneumonia and urinary tract infection accounted for 50.0% (14/28) and 42.9% (12/28), respectively. All infected patients were cured or improved with fosfomycin and/or carbapenem-containing combination therapy, except one case in whom treatment was withdrawn. All 47 cases of CR-KPN were resistant to ertapenem and 95.7% were resistant to imipenem/meropenem. Overall, 87.2% (41/47) were positive for bla(NDm-1), and belonged to 11 pulsed-field gel electrophoresis types; 53.7% (22/41) were designated as ST278 and 17.1% (7/41) were designated as ST2735 by multilocus sequence typing. Conclusions: Most of the CR-KPN isolated from neonates produced New Delhi metallobeta-lactamase-1 and were highly homologous. Fosfomycin-containing regimens and meropenem-/panipenem-containing combination therapy were efficient for CR-KPN infection in neonates. (C) 2018 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.