Risk Factors for Late-Onset Gut Decolonization in Pediatric CRGNB-Carriers

Risk factors for late-onset gut decolonization of carbapenem-resistant gram-negative bacteria (CRGNB) among pediatric patients include the duration of carbapenem, proton pump inhibitor (PPI), and steroid use; length of hospitalization; number of readmissions; and prior abdominal surgical procedure. These findings were published in the Journal of Hospital Infection.

Researchers conducted a study to investigate modifiable and non-modifiable risk factors for late-onset gut decolonization among pediatric CRGNB-carriers. Eligible patients included those aged 1 day to 16 years who were hospitalized at a tertiary care hospital between 2018 and 2019. Following CRGNB detection, rectal swabs were collected for culture analysis once weekly during hospitalization and once monthly after discharge for 12 months. Mann-Whitney U, Kruskal-Wallis H, chi-square, and Fisher exact testing were used to compare demographic differences between patients who experienced decolonization before vs after 6 months. Factors associated with late-onset decolonization were assessed via univariate and multivariable Cox regression.

The final analysis included 130 patients, of whom the median age was 1.3 months (range, 2 days to 16 years), 53.1% were girls, and the median number of hospital readmissions was 2.

The median duration of CRGNB carriage was 97 (range, 21-882) days, with carriage persisting for at least 6 months among 47 (36.2%) patients and for at least 12 months among 7 (5.4%) patients. The most commonly isolated species among the patients was Klebsiella pneumoniae (70.8%). Targeted organisms and detected carbapenemases did not signficiantly differ between patients who experienced decolonization before vs after 6 months.

In the multivariable analysis, independent risk factors for late-onset decolonization were as follows:

• Use of carbapenems (hazard ratio [HR], 0.52; 95% CI, 0.30-0.91);
• Use of PPIs (HR, 0.39; 95% CI, 0.24-0.64);
• Number of hospital readmissions (HR, 0.90; 95% CI, 0.86-0.96);
• Immunosuppression (HR, 0.52; 95% CI, 0.31-0.87); and
• Urinary catheter placement (HR, 0.42; 95% CI, 0.24-0.76).

Duration of PPI, carbapenem, and steroid use; total length of hospitalization; and prior abdominal surgical procedure also were associated with increased risk for late-onset gut decolonization.

This study was potentially limited by the use of self-reported data and the inclusion of patients with comorbid conditions.

According to the researchers, “It is essential to understand the factors associated with later decolonization to improve policies related to the implementation of targeted screening and preemptive contact precautions.”