A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children
| Autor: | Mary K. Hayden, Latania K. Logan, Robert A. Weinstein, Nadia K. Qureshi, Rachel L Medernach, Susan D. Rudin, Jared R. Rispens, T. Nicholas Domitrovic, Steven H. Marshall, Robert A. Bonomo, Andrea M. Hujer, Xiaotian Zheng |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Microbiology (medical) medicine.medical_specialty Klebsiella Adolescent medicine.drug_class medicine.medical_treatment Antibiotics Drug resistance beta-Lactamases Article 03 medical and health sciences 0302 clinical medicine Bacterial Proteins Risk Factors 030225 pediatrics Internal medicine Intensive care Enterobacterales Drug Resistance Bacterial Epidemiology polycyclic compounds otorhinolaryngologic diseases medicine Humans 030212 general & internal medicine Child Retrospective Studies Chicago Molecular Epidemiology biology Molecular epidemiology business.industry Infant Newborn Infant Bacterial Infections biochemical phenomena metabolism and nutrition bacterial infections and mycoses biology.organism_classification Anti-Bacterial Agents Infectious Diseases Case-Control Studies Child Preschool Pediatrics Perinatology and Child Health Beta-lactamase bacteria Female business Gammaproteobacteria |
| Zdroj: | Pediatr Infect Dis J |
| ISSN: | 0891-3668 |
| DOI: | 10.1097/inf.0000000000002916 |
| Popis: | BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales-(Ent) infections are increasing in pediatrics. Before CTX-M ESBL emerged, the most common infection-associated ESBL genes were TEM and SHV-type ESBLs. We sought to define the current epidemiology of Ent infections in children due to blaTEM and blaSHV (TEM-SHV-Ent). METHODS A retrospective case-control analysis of children with TEM-SHV-Ent infections at 3 Chicago-area hospitals was performed. Cases had extended-spectrum-cephalosporin (ESC)-resistant infections due to blaTEM or blaSHV. DNA analysis assessed β-lactamase (bla) genes, multilocus sequence types, and E. coli phylogenetic grouping. Controls had ESC-susceptible Ent infections, matched 3:1 to cases by age, source, and hospital. Clinical-epidemiologic infection predictors were assessed. RESULTS Of 356 ESC-R-Ent isolates from children (median 4.3 years), 38 (10.7%) were positive solely for blaTEM-ESBL (26%) or blaSHV-ESBL genes (74%). Predominant organisms were Klebsiella (34.2%) and E. coli (31.6%); 67% of E. coli were phylogroup B2. Multilocus sequence types revealed multiple strains, 58% resistant to ≥3 antibiotic classes. On multivariable analysis, children with TEM-SHV-Ent infections more often had recent inpatient care (OR, 8.2), yet were diagnosed mostly as outpatients (OR, 25.6) and less in Neonatal Intensive Care Units (OR, 0.036) than controls. TEM-SHV-Ent patients had more gastrointestinal (OR, 23.7) and renal comorbidities (OR, 4.2). Differences in demographics, antibiotic exposure, and foreign bodies were not found. CONCLUSION TEM-SHV-Ent are commonly linked to inpatient exposures in children with chronic conditions but most often present in outpatient settings. Clinicians should be aware of the potential increased risk for TEM-SHV-Ent infections in outpatients with gastrointestinal and renal comorbidities and histories of prolonged hospital stays. |
| Databáze: | OpenAIRE |
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