This article synthesizes findings of a comprehensive, seven-year (2016-2022) multi-center study that investigated the pathogen distribution and drug resistance of gram-negative bacteria causing bloodstream infections (BSIs) amongst pediatric patients in China.
The research was facilitated by the Infectious Disease Surveillance of Pediatric (ISPED), whose reach expanded to 12 tertiary children’s hospitals in nine provinces or autonomous cities across China. The study’s analytical scope included only the data of gram-negative bacteria derived exclusively from blood samples collected from the patients participating in the ISPED study. To robustly scrutinize the vast reservoir of accumulated susceptibility data and to determine the trend lines in antimicrobial resistance of the critical pathogens, only data culled from the initial cohorts of participating hospitals over the years was considered.
In order to avoid data proliferation, contaminating bacteria and duplicate strains were ruled out. The bacterial isolates were identified by deploying a variety of identification methods such as the Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and the VITEK2-Compact automatic bacterial identification and drug sensitivity instrument among others. Antimicrobial susceptibility testing was carried out employing either minimum inhibitory concentration (MIC) method, Kirby–Bauer method, or E-test method. The results were interpreted under the guidance of the Clinical and Laboratory Standards Institute (CLSI) M100-S32 guidelines from 2022.
Significantly, a total of 394100 pathogenic bacterial strains were isolated from the ISPED study conducted from 2016 to 2022. Out of these, 39977 strains were associated with bloodstream infections, constituting 10.1% of the total. Around 27.1% or 10824 strains were caused by negative bacteria. The top 10 negative bacteria causing BSIs were identified, with E. coli (23.8%) and S. maltophilia (18.9%) being at the top of the list.
The study concluded that the rate of gram-negative pathogens displayed an increasing trend for bloodstream infections. Carbapenem-resistant K. pneumoniae (CRKPN) exhibited a declining detection rate in 2018. There were evident disparities in the types of pathogens between the neonatal group and the pediatric group, with the detection rate of CRKPN in the neonate group significantly surpassing the pediatric group.
Alarmingly, these data exposed a high level of antimicrobial resistance that poses grave threats to children’s health, thereby pressing for the implementation of effective antimicrobial resistance monitoring and stewardship among children in China.