Epidemiology of Antimicrobial Resistance and Utilization in Children with Central Line Associated Bloodstream Infections (CLABSIS) in Greece

METHODS: We conducted active surveillance for CLABSIs and antibiotic use in intensive care units, oncology and transplant units at 2 children's hospitals in Greece between September-December 2012. CLABSIs were prospectively identified using CDC definitions. An antibiotic day (AD) was defined as a calendar day in which at least one antimicrobial was given.

RESULTS: 28 CLABSIs were identified from 22 children. Gram negative organisms were most commonly isolated (18, 64.2%): Klebsiella spp. (6, 33.3%), Enterobacter spp. (5, 27.7) and Escherichia coli (4, 22.2%). Resistance to third generation cephalosporins (likely ESBLs) were detected in 66.6% of Klebsiella spp. Carbapenem resistance was noted in 1 isolate of Klebsiella. CLABSIs were also caused by Candida spp (6, 21.4%) and gram-positive organisms 4 (14.2%), including 1 resistant isolate (vancomycin-resistant Enterococcus faecium).  

On surveillance units there were 3423 antibiotic days during 6246 patient days (antibiotic utilization ratio 0.548). Meropenem (39%), amikacin (32%), and teicoplanin (28.5%) were the most frequently used antimicrobials.  

CONCLUSIONS: The majority of pathogens causing CLABSIs in hospitalized children in Greece were MDROs requiring use of broad-spectrum antibiotics. These findings call for rapid and effective adoption of infection control and antimicrobial stewardship strategies to prevent further emergence and spread of MDROs.