Community Origins and Regional Differences Highlight Risk of Plasmid-mediated Fluoroquinolone Resistant Enterobacteriaceae Infections in Children

Autor: Nadia K. Qureshi, Mary K. Hayden, Susan D. Rudin, Robert A. Bonomo, Steven H. Marshall, Latania K. Logan, Robert A. Weinstein, Andrea M. Hujer, T. Nicholas Domitrovic, Jared R. Rispens, Rachel L Medernach, Sreenivas Konda, Xiaotian Zheng
Rok vydání: 2019
Předmět:
DNA
Bacterial

Microbiology (medical)
medicine.medical_specialty
Adolescent
medicine.drug_class
education
Cephalosporin
Microbial Sensitivity Tests
Drug resistance
Gene mutation
Article
Tertiary Care Centers
Young Adult
03 medical and health sciences
0302 clinical medicine
Enterobacteriaceae
Risk Factors
Drug Resistance
Multiple
Bacterial

030225 pediatrics
Internal medicine
Epidemiology
otorhinolaryngologic diseases
Humans
Medicine
030212 general & internal medicine
Child
Chicago
Molecular epidemiology
business.industry
Enterobacteriaceae Infections
Infant
Newborn

Case-control study
Infant
Odds ratio
Anti-Bacterial Agents
3. Good health
Community-Acquired Infections
Multiple drug resistance
Infectious Diseases
Case-Control Studies
Child
Preschool

Pediatrics
Perinatology and Child Health

business
Fluoroquinolones
Plasmids
Zdroj: Pediatr Infect Dis J
ISSN: 0891-3668
DOI: 10.1097/inf.0000000000002205
Popis: Background Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children. Methods A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. Results Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found. Conclusions The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
Databáze: OpenAIRE