Infections Due to Antibiotic-resistant Gram-negative Bacteria in Pediatrics: Possible Management Strategies

Antimicrobial Activity of Imipenem/Relebactam and Comparator Agents Against Gram-Negative Isolates Collected From Pediatric Patients: SMART 2018-2022 Global Surveillance

OBJECTIVES

To evaluate the in vitro susceptibility of recent Gram-negative pathogens collected from pediatric patients to imipenem/relebactam (IMI/REL) and comparator agents.

METHODS

From 2018 to 2022 254 hospitals in 62 countries collected Enterobacterales or Pseudomonas aeruginosa isolates from patients <18 years old as part of the SMART global surveillance program. Minimum inhibitory concentrations (MIC)s were determined using CLSI broth microdilution and interpreted with 2024 CLSI breakpoints. Most isolates non-susceptible to IMI/REL were queried for their acquired β-lactamase content.

RESULTS

Overall, 96.8% of all non-Morganellaceae Enterobacterales (NME) isolates from pediatric patients (n = 12 060) were IMI/REL-susceptible. Most NME were also susceptible to imipenem alone (93.9%), meropenem (96.0%), and ertapenem (94.4%); isolates were less susceptible to piperacillin/tazobactam (82.8%), cefepime (76.3%), and ceftazidime (74.4%). Non-Morganellaceae Enterobacterales collected in Asia were the least susceptible to IMI/REL (91.6%), while those from Australia/New Zealand were the most (99.3%). Imipenem/relebactam was equally potent against NME isolates regardless of infection source, hospital ward, age, and length of hospitalization. In total, 90.8% of all Pseudomonas aeruginosa isolates (n = 3046) were IMI/REL-susceptible; ceftolozane/tazobactam also inhibited >90% of the P. aeruginosa. Regionally, P. aeruginosa isolates from Eastern Europe were least susceptible to IMI/REL. Molecular characterization revealed that, globally, most resistance to IMI/REL among the NME could be attributed to the presence of NDM-type metallo-β-lactamases, while no acquired β-lactamases were detected in approximately half the IMI/REL non-susceptible P. aeruginosa examined.

CONCLUSION

Based on in vitro data, IMI/REL represents a good therapeutic option for most hospitalized pediatric patients infected with common Gram-negative pathogens.

Epidemiology of bloodstream infections and the impact of antimicrobial resistance in pediatric hematopoietic cell transplant

Bloodstream infections (BSI) pose a substantial threat to the well-being and survival of patients undergoing hematopoietic stem cell transplantation (HSCT). Risk factors for these infections vary across the different post-HSCT phases. In the pre-engraftment period, patients are particularly susceptible to infection due to prolonged neutropenia, mucosal damage, and extensive use of central venous line (CVL). In the post-engraftment phase, the emergence of graft versus host diseases further compounds the risk. The epidemiology of these infections has undergone notable changes over the years due to multifactorial reasons, including the evolution of protocols that intensify immunosuppression. In this context, the emergence of multi-drug resistance (MDR) microorganisms can be a challenge due to the elevated risk of mortality in these vulnerable patients. Unfortunately, there is a lack of comprehensive data on this topic, particularly in pediatrics. This article aims to provide a summary of the epidemiology of BSI in the different post-transplant phases and the impact of MDR pathogens. Having knowledge about the local epidemiology of BSI can be instrumental in tailoring targeted therapies, leading to improved survival rates in HSCT recipients.

Antibacterial effect of rose bengal against colistin-resistant gram-negative bacteria

Increasing drug resistance in Gram-negative bacteria presents significant health problems worldwide. Despite notable advances in the development of a new generation of β-lactams, aminoglycosides, and fluoroquinolones, it remains challenging to treat multi-drug resistant Gram-negative bacterial infections. Colistin (polymyxin E) is one of the most efficacious antibiotics for the treatment of multiple drug-resistant Gram-negative bacteria and has been used clinically as a last-resort option. However, the rapid spread of the transferable gene, mcr-1 which confers colistin resistance by encoding a phosphoethanolamine transferase that modifies lipid A of the bacterial membrane, threatens the efficacy of colistin for the treatment of drug-resistant bacterial infections. Colistin-resistant strains of Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae often reduce their susceptibility to other anti-Gram-negative bacterial agents. Thus, drugs effective against colistin-resistant strains or methods to prevent the acquisition of colistin-resistance during treatment are urgently needed. To perform cell-based screenings of the collected small molecules, we have generated colistin-resistant strains of E. coli, A. baumannii, K. pneumoniae, P. aeruginosa, and S. enterica Typhimurium. In-house MIC assay screenings, we have identified that rose bengal (4,5,6,7-tetrachloro-2',4',5',7'-tetraiodofluorescein) is the only molecule that displays unique bactericidal activity against these strains at low concentrations under illumination conditions. This article reports the antibacterial activity of a pharmaceutical-grade rose bengal against colistin-resistant Gram-negative bacteria.