Modifiable risk factors associated with later gut decolonization of carbapenem-resistant Gram-negative bacteria in children: A prospective cohort study.

BACKGROUND: Nosocomial infections caused by carbapenem-resistant gram-negative bacteria (CRGNB) are associated with increased mortality and prolonged hospitalization; thus, later CRGNB-decolonization has significant clinical and public health implications.

AIM: We investigated modifiable/ non-modifiable risk factors for CRGNB-later gut decolonization in children.

METHODS: We included CRGNB-carriers (1day-16years old), hospitalized in a tertiary-level hospital (2018-2019). Upon CRGNB-carriage detection, rectal-swab cultures were taken weekly, if patients were hospitalized and monthly after discharge for 12 months. CRGNB-decolonization was defined as three consecutive negative rectal-swab cultures obtained ≥1 week apart. Modifiable (treatment administered/medical devices) and non-modifiable (age/gender/comorbidities) risk factors were recorded. Cox regression for later CRGNB-decolonization was performed.

FINDINGS: One hundred thirty CRGNB-carriers were recorded. After 12 months, 5.4% remained carriers. Risk factors for later decolonization were immunosuppression (HR: 0.52, 95%CI: 0.31-0.87), carbapenems (HR: 0.52, 95%CI: 0.30-0.91), proton-pump inhibitors (PPIs) (HR: 0.39, 95%CI: 0.24-0.64) and their duration of use, duration of hospitalization (HR: 0.90, 95%CI: 0.81-0.92, per 10 days), number of re-admissions (HR: 0.90, 95%CI: 0.86-0.96), abdominal surgery (HR: 0.33, 95%CI: 0.17-0.65), urinary catheter (HR: 0.42, 95%CI: 0.24-0.76) and duration of steroid administration (HR: 0.86, 95%CI: 0.84-0.88, per 10 days).

CONCLUSIONS: Carbapenems, PPIs and their duration of use, duration of steroids use, immunosuppression, urinary catheter, re-admissions, duration of hospitalization, and abdominal surgery are associated with later CRGNB-decolonization among children. Paediatric patients at risk of later decolonization should be under targeted screening and preemptive contact precautions. Known carriers at risk of later CRGNB-decolonization should be under meticulously applied contact precautions for longer durations.