The risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

QIN Fang ^1,2,3,4 , HUANG Liang ^1,2,3,4 , ZHANG Chuan ^2,3,4 , SHI Jing ⁵ , ZENG Linan ^2,3,4 , LI Hailong ^2,3,4 ,  ZHANG Lingli ^2,3,4 ,  WANG Ling ¹

1. West China School of Pharmacy, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
4. Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610041, P.R.China;
5. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

ZHANG Lingli, Email: zhanglingli@scu.edu.cn; WANG Ling, Email: rebeccawang312@gmail.com

Keywords：

Carbapenem-resistant enterobacteriaceae; Colonization; Infection; Neonates; Systematic review; Case-control study

DOI：

10.7507/1672-2531.202009061

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Objectives To systematically review the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort or case-control studies on the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies, and meta-analysis was performed by RevMan5.3 software.Results A total of 9 case-control studies involving 759 patients were included. The results of meta-analysis showed that, maternal factors like placental abruption (OR=6.25, 95%CI 1.47 to 26.61, P=0.01), premature rupture of fetal membranes of parturient (OR=5.62, 95%CI 2.63 to 12.00, P<0.000 01), pregnancy-induced hypertension (OR=2.04, 95%CI 1.49 to 2.80, P<0.000 01), carbapenem antibiotics used in mothers (OR=1.77, 95%CI 1.10 to 2.81, P=0.017), neonatal factors like premature delivery (OR=1.96, 95%CI 1.06 to 3.61, P=0.03), mechanical ventilation (OR=2.14, 95%CI 1.01 to 4.55, P=0.05), surgical procedure (OR=14.17, 95%CI 2.46 to 81.70, P=0.003), umbilical vein catheter (OR=1.93, 95%CI 1.20 to 3.11, P=0.007), peripherally inserted central catheter (OR=4.30, 95%CI 1.86 to 9.93, P=0.000 6), nasogastric feeding (OR=4.37, 95%CI 1.44 to 13.29, P=0.009), use of carbapenems (OR=3.04, 95%CI 1.91 to 4.84, P<0.000 01), and admission to NICU (OR=2.78, 95%CI 1.79 to 4.33, P<0.000 01) were the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Breastfeeding (OR=0.30, 95%CI 0.13 to 0.70, P=0.005) was the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates.Conclusions The current evidence shows that maternal factors like placental abruption, premature rupture of fetal membranes, pregnancy-induced hypertension, carbapenem antibiotics used in mothers, and neonatal factors like premature delivery, mechanical ventilation, surgical procedure, umbilical vein catheter, peripherally inserted central catheter, nasogastric feeding, use of carbapenems, and admission to NICU are the risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates; while breastfeeding is the protective factor of carbapenem-resistant enterobacteriaceae colonization or infection in neonates. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the conclusions.

Citation： QIN Fang, HUANG Liang, ZHANG Chuan, SHI Jing, ZENG Linan, LI Hailong, ZHANG Lingli, WANG Ling. The risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates: a systematic review. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1390-1396. doi: 10.7507/1672-2531.202009061 Copy

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15.	刘媛, 王婉霞. 新生儿 CRKP 院内感染性肺炎的危险因素分析. 海南医学, 2020, 31(1): 62-65.
16.	李书津, 徐发林, 李文丽, 等. 早产儿耐碳青霉烯类肺炎克雷伯菌败血症 23 例临床分析. 中华新生儿科杂志(中英文), 2019, 34(5): 329-333.
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19.	曹阳, 毛静秋, 魏殿军, 等. 新生儿碳青霉烯类耐药肺炎克雷伯菌的耐药性及其定植的危险因素分析. 中华临床感染病杂志, 2015, (5): 407-412.
20.	马明圣, 王丹华, 孙秀静, 等. 新生儿发生产肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌定植的危险因素分析. 中国当代儿科杂志, 2014, (10): 970-974.
21.	Chabah M, Chemsi M, Zerouali K, et al. Healthcare-associated infections due to carbapenemase-producing Enterobacteriaceae: Bacteriological profile and risk factors. Med Mal Infect, 2016, 46(3): 157-162.
22.	Giuffrè M, Bonura C, Geraci DM, et al. Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy. J Hosp Infect, 2013, 85(3): 233-236.
23.	乔甫, 宗志勇. 世界卫生组织《医疗机构耐碳青霉烯的肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌防控指南》介绍. 华西医学, 2018, 33(3): 259-263.
24.	王强, 李幼平, 张伯礼, 等. 指南临床适用性评价的问题与需求. 中国循证医学杂志, 2020, 20(3): 249-251.
25.	Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol, 2017, 186(12): 1319-1328.
26.	Yahya L, Alhubaishi A. Premature rupture of membrane and neonatal infection. Open J Obstet Gynecol, 2019, 9: 1388-1391.
27.	Mouzinho A, Rosenfeld CR, Sanchez PJ, et al. Effect of maternal hypertension on neonatal neutropenia and risk of nosocomial infection. Pediatrics, 1992, 90(3): 430-435.
28.	Collins A, Weitkamp JH, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed, 2018, 103(4): F391-F394.
29.	刘银梅, 史庆丰, 吴晓松, 等. 耐碳青霉烯类肺炎克雷伯菌血流感染危险因素的 Meta 分析. 中国消毒学杂志, 2020, 37(7): 513-517, 520.
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1. CDC. Facility guidance for control of carbapenem-resistant enterobacteriaceae (CRE), 2020-06-20. Available at: https://www.cdc.gov/hai/pdfs/cre/cre-guidance-508.pdf.
2. Nordmann P, Naas T, Poirel L. Global spread of Carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis, 2011, 17(10): 1791-1798.
3. Falagas ME, Tansarli GS, Karageorgopoulos DE, et al. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis, 2014, 20(7): 1170-1175.
4. WHO. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics, 2020-06-20. Available at: https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/.
5. 付盼, 王传清, 俞蕙, 等. 中国儿童细菌耐药监测组 2017 年儿童细菌感染及耐药监测. 中国循证儿科杂志, 2018, 13(6): 406-411.
6. 胡付品, 郭燕, 朱德妹, 等. 2017 年 CHINET 中国细菌耐药性监测. 中国感染与化疗杂志, 2018, 18(3): 241-251.
7. 刘伟, 赖晓全, 谭昆, 等. 新生儿肺炎克雷伯菌医院感染预后相关因素分析. 中华医院感染学杂志, 2019, 29(13): 2024-2028.
8. 姚恩凤, 孙玄, 姜丽, 等. 新生儿耐碳青霉烯类肺炎克雷伯菌败血症临床分析. 中华新生儿科杂志(中英文), 2019, 34(2): 119-124.
9. van Loon K, Voor In 't Holt AF, Vos MC. A systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant enterobacteriaceae. Antimicrob Agents Chemother, 2017, 62(1): e01730-1717.
10. WHO. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities, 2020-06-20. Available at: https://www.who.int/infection-prevention/publications/guidelines-cre/en/.
11. Magiorakos AP, Burns K, Rodríguez Baño J, et al. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from ECDC. Antimicrob Resist Infect Control, 2017, 6: 113.
12. 中华人民共和国国家卫生. 关于印发碳青霉烯类抗菌药物临床应用专家共识等 3 个技术文件的通知, 2020-06-20. Available at: http://www.nhc.gov.cn/yzygj/s7659/201809/95f65ca473b44746b24590e94468b8ff.shtml.
13. Wells G, Shea B, O'connell DL, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Appl Eng Agric, 2014, 18(6): 727-734.
14. 王芳, 鲁巧云, 胡凤琪, 等. 医院感染嗜麦芽窄食单胞菌危险因素的 Meta 分析. 中国感染控制杂志, 2020, 19(2): 131-136.
15. 刘媛, 王婉霞. 新生儿 CRKP 院内感染性肺炎的危险因素分析. 海南医学, 2020, 31(1): 62-65.
16. 李书津, 徐发林, 李文丽, 等. 早产儿耐碳青霉烯类肺炎克雷伯菌败血症 23 例临床分析. 中华新生儿科杂志(中英文), 2019, 34(5): 329-333.
17. 李秋阳, 金凤玲. 儿科重症监护室耐碳青霉烯类肠杆菌科细菌的分布特征及危险因素分析. 国际检验医学杂志, 2019, 40(16): 1980-1984, 1988.
18. 谭莉, 凃敏, 彭威军, 等. 新生儿耐碳青霉烯类肺炎克雷伯菌医院感染相关因素分析. 中华医院感染学杂志, 2018, 28(18): 2811-2814.
19. 曹阳, 毛静秋, 魏殿军, 等. 新生儿碳青霉烯类耐药肺炎克雷伯菌的耐药性及其定植的危险因素分析. 中华临床感染病杂志, 2015, (5): 407-412.
20. 马明圣, 王丹华, 孙秀静, 等. 新生儿发生产肺炎克雷伯碳青霉烯酶的肺炎克雷伯菌定植的危险因素分析. 中国当代儿科杂志, 2014, (10): 970-974.
21. Chabah M, Chemsi M, Zerouali K, et al. Healthcare-associated infections due to carbapenemase-producing Enterobacteriaceae: Bacteriological profile and risk factors. Med Mal Infect, 2016, 46(3): 157-162.
22. Giuffrè M, Bonura C, Geraci DM, et al. Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy. J Hosp Infect, 2013, 85(3): 233-236.
23. 乔甫, 宗志勇. 世界卫生组织《医疗机构耐碳青霉烯的肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌防控指南》介绍. 华西医学, 2018, 33(3): 259-263.
24. 王强, 李幼平, 张伯礼, 等. 指南临床适用性评价的问题与需求. 中国循证医学杂志, 2020, 20(3): 249-251.
25. Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol, 2017, 186(12): 1319-1328.
26. Yahya L, Alhubaishi A. Premature rupture of membrane and neonatal infection. Open J Obstet Gynecol, 2019, 9: 1388-1391.
27. Mouzinho A, Rosenfeld CR, Sanchez PJ, et al. Effect of maternal hypertension on neonatal neutropenia and risk of nosocomial infection. Pediatrics, 1992, 90(3): 430-435.
28. Collins A, Weitkamp JH, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed, 2018, 103(4): F391-F394.
29. 刘银梅, 史庆丰, 吴晓松, 等. 耐碳青霉烯类肺炎克雷伯菌血流感染危险因素的 Meta 分析. 中国消毒学杂志, 2020, 37(7): 513-517, 520.
30. 唐丽玲, 张培金, 钱丽华, 等. 我国碳青霉烯类耐药肺炎克雷伯菌感染危险因素 Meta 分析. 中国消毒学杂志, 2019, 36(3): 199-202, 205.

Chinese Journal of Evidence-Based Medicine

The risk factors of carbapenem-resistant enterobacteriaceae colonization or infection in neonates: a systematic review

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