1430. A Multicenter Study of Extended Spectrum Beta-Lactamase producing Enterobacteriaceae Infections in Children
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • IDSA POSTER FINAL.jpg (644.0 kB)
  • Background: Infections due to extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae have been well studied in adults but data in children are limited.

    Methods:  We conducted a retrospective, case-case-control study of children at two large tertiary care centers in Chicago, IL from 2008-2011. Subjects were identified by review of microbiology data bases.  Cases were defined as children (0-17yrs) with ESBL or non-ESBL infection by NHSN criteria; controls (children with negative cultures) were matched 1:1 by age, healthcare setting, specimen source and time period. Records were reviewed for risk factors, clinical history and outcomes.  To study differences between groups, Fisher's exact test and ANOVA were used. If significant differences were found, Fisher's exact and Wilcoxon rank sum tests were used to see which pairs of groups were different. 

    Results: Thirty cases of ESBL infection were identified; study period incidence was 1.6% and did not significantly change over time. Common sources of ESBL isolates were urine (62%), sputum (19%) and blood (6%).  The majority of ESBL isolates were Escherichia coli (79%); 77% were resistant to ≥2 antibiotic classes. The median age of ESBL case patients was 1.75 yrs, 67% were female and 40% were premature.  Presentation in an ambulatory setting was common (40%).  Infection recurred in 17%. In comparing ESBL case patients to controls, case patients were significantly more likely to have had recent healthcare exposure (90% vs. 67%, p=0.030), gastrointestinal (60% vs. 20%, p=0.002) or neurologic (53% vs. 17%, p=0.003) comorbidities. ESBL compared to non-ESBL case patients were more likely to have received antibiotics prior to culture (80% vs. 50%, p=0.016), a ventilatory device (47% vs. 20%, p=0.030) or a neurologic comorbidity (53% vs. 27%, p=0.037).  There were no significant differences between non-ESBL case patients and controls. In-hospital mortality (11%) was similar among groups.

    Conclusion: The incidence of pediatric infection due to ESBL-positive Enterobacteriaceae was low and stable at two large tertiary care medical centers over a four year period.  Presentation in an ambulatory setting was common but most ESBL case patients had medical comorbidities, recent healthcare and antibiotic exposures. 

     

    Laura A. Meltzer, MD1,2, James B. McAuley, MD, MPH, DTM&H1,2,3, Kumar Rajan, PhD1, Mary Hayden, MD, FSHEA1,2, Robert Weinstein, MD1,2,4, Latania K. Logan, MD1,2,4 and for the CDC Prevention Epicenter Program, (1)Rush University Medical Center, Chicago, IL, (2)Rush Medical College, Chicago, IL, (3)Centers for Disease Control and Prevention, Atlanta, GA, (4)John Stroger Hospital of Cook County, Chicago, IL

    Disclosures:

    L. A. Meltzer, None

    J. B. McAuley, None

    K. Rajan, None

    M. Hayden, None

    R. Weinstein, None

    L. K. Logan, None

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