title: Molecular characterization and risk factors for carbapenem-resistant Gram-negative bacilli colonization in children: emergence of NDM-producing Acinetobacter baumannii in a newborn intensive care unit in Turkey.
abstract: BACKGROUND
  Multidrug-resistant Gram-negative bacilli are responsible for more than 50% of healthcare-associated infections. Colonization dynamics, characteristics, and risk factor data for CR-GNB are scarce in children.
  
  
  OBJECTIVE
  To examine the molecular characteristics of, and risk factors for nosocomial colonization with, carbapenem-resistant Gram-negative bacilli (CR-GNB) in hospitalized paediatric patients in a tertiary university hospital's paediatric units in Turkey.
  
  
  METHODS
  A prospective case-control study was performed at a university hospital in Istanbul, Turkey.
  
  
  RESULTS
  A total of 1840 rectal swab specimens were collected from all 762 hospitalized children between March 2013 and October 2013. Among them, 176 (23%) patients were colonized with CR-GNB. Of these, 72 (9%) patients were colonized with carbapenem-resistant Enterobacteriaceae, 138 (18%) with CR-non-fermenter Gram-negative bacilli (CR-NF) and 34 (4%) with both. The median CR-GNB colonization time was 10 days (range: 1-116). The median duration of rectal colonization with CR-GNB was 8 days (range: 1-160). NDM (31%) was the second most frequent carbapenemase identified in Acinetobacter baumannii isolates, and has not previously been detected in Turkey. All of the 17 patients colonized with NDM-producing A. baumannii were newborns in the neonatal intensive care unit. Independent risk factors for CR-GNB colonization were: age <1 year, nasogastric tube placement, presence of underlying chronic diseases, ampicillin usage, surgical intervention, and carbapenem use.
  
  
  CONCLUSIONS
  This is the first description of NDM in A. baumannii in newborn units in Turkey. Carbapenem usage is a common independent risk factor for both CRE and CR-NF colonization, which underscores the importance of antibiotic stewardship programmes.
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Karaaslan
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Soysal
authors.affiliation: Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Altinkanat Gelmez
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Kepenekli Kadayifci
authors.affiliation: Department of Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Söyletir
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, Marmara University School of Medicine, Istanbul, Turkey. Electronic address: mbakir@marmara.edu.tr.
authors.forename: M
authors.initials: M
authors.lastname: Bakir
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D005260:Female; D005838:Genotype; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014421:Turkey / Q000453:epidemiology; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Acinetobacter baumannii; Carbapenem resistance; Children; Colonization; Gram-negative bacilli; NDM