1417. Carbapenem-Resistant Enterobacteriaceae (CRE) in Pediatric Patients: Epidemiology and Risk Factors
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
  • ID week poster 2012 FINAL.pdf (413.1 kB)
  • Background:   The incidence of CRE in the US has been steadily rising since the first reported outbreak of carbapenem-resistant Klebsiella pneumoniae and Enterobacter species in 2003. Risk factors for CRE in adults have been well described, but data are lacking in pediatric populations.

    Methods: A case-control study was performed among pts hospitalized at Children's National Medical Center between 8/2009 and 8/2011 for gastrointestinal (GI) complaints or underlying GI disease. Cases had one or more clinical or surveillance cultures confirmed positive for CRE by modified Hodge testing. Cases were individually matched to four control pts by age as defined by the American Academy of Pediatrics. Controls were randomly selected from pts without positive CRE cultures. Conditional logistic regression was conducted to identify independent risk factors for CRE, adjusted for underlying GI condition.

    Results: Thirteen cases with CRE infection (46%) or colonization (54%) were identified. These pts ranged from 6 months to 18 years, with an average age of 4.2 years. The most common organism was K pneumoniae (62%) followed by Escherichia coli (15%) and Enterobacter cloacae (15%). The majority (77%) of cases had GI disease. In the 12 months prior to onset of CRE, all cases had previous hospitalizations and 84.6% received 3 or more antibiotics. The most common sites of infection were intra-abdominal (39%) followed by urinary tract (31%).  Analysis identified the following risk factors: 1) prior exposure to penicillin (Odds Ratio [OR]=44.2, p=0.002), 3rd generation cephalosporin (OR=14.8, P=0.012), carbapenem (OR=12.6, p=0.003), fluroquinolone (OR=8.7, p=0.002), or trimethoprim/sulfamethoxazole (OR=6.5, p=0.009); 2) prior history with a vancomycin resistant Enterococcus (OR=8.6, p=0.01) or an extended spectrum beta-lactamase producing Enterobacteriaceae family member (OR=9.5, p=0.007) colonization or infection.

    Conclusion: This study evaluated a large group of CRE colonized/infected pediatric gastroenterology patients and demonstrated that prior antibiotic exposure and a history of antibiotic resistant organisms are significant risk factors for CRE acquisition. Further studies are warranted to identify measures to ameliorate the risk of CRE.

    Sahera Dirajlal-Fargo, D.O., Pediatrics, Children's National Medical Center, Washington, DC, Roberta DeBiasi, MD, Children's National Medical Center/Children's Research Institute, Washington, DC, Joseph Campos, Children's National Medical Center, Washington, DC and Xiaoyan Song, PhD, MBBS, George Washington University School of Medicine, Washington, DC


    S. Dirajlal-Fargo, None

    R. DeBiasi, None

    J. Campos, None

    X. Song, None

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