292. Increasing ESBL Infections in Children- an Emerging Pediatric Challenge?
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • 292_IDWeekPoster_41670_ESBL_CHOC.pdf (410.2 kB)
  • Background: We have noted an increased number of children at our institution with infection due to gram-negative bacteria producing extended-spectrum beta-lactamases (ESBLs). We sought to characterize these children over a twelve year period in order to better understand the changing epidemiology of these infections.

    Methods: We identified all patients who had an ESBL producing organism cultured at our institution, and reviewed their medical records. We compared characteristics of those from 2001-2006 to 2007-2012.

    Results:   In the first time period, there were 47 isolates from 44 patients, compared with 151 isolates in 123 patients in the second time period, representing a 280% increase.  Of these isolates, there was a noticeable increase in the proportion that were community acquired (CA) (Figure 1). Site of isolation is represented in Figure 2.  While isolates from all sites of infection increased in number, only urine isolates increased as a proportion of the total, from 25% to 61%.  There was a shift in organism distribution, with a preponderance of E.coli isolates in the second time period (Figure 3).  In the first time period, 6% of isolates were cultured in the outpatient setting, as opposed to 25% in the second. Most (122/167, 73%) patients had an underlying medical condition; however, the proportion of healthy patients increased from 5% to 35%.  Thirty-five(21%)  patients were colonized with another multi-drug resistant organism. There were 13 healthy infants ≤ 6 months of age who presented with urinary tract infection, all in the second half of the study period.  Ten patients expired over the study period, none due to ESBL infection.

    FIGURE 1 .gif

    FIGURE 2.gif

    FIGURE 3.gif

    Conclusion:   The number of pediatric patients with infection due to ESBL producing organisms is increasing at our institution, with CA isolates, urine isolates and ESBL E. coli becoming more prominent. Although the majority of infections continue to be seen in children with underlying medical conditions, the proportion of infections seen in healthy children has increased, notably in healthy infants ≤ 6 months of age.  Length of isolation, surveillance and clearance procedures for this increasing number of patients needs to be studied.

    Jasjit Singh, MD1, Delma Nieves, MD1, Negar Ashouri, MD1 and Wendi Gornick, MS, CIC2, (1)Infectious Diseases, CHOC Children's Hospital, Orange, CA, (2)Infection Prevention and Epidemiology, CHOC Children's Hospital, Orange, CA


    J. Singh, None

    D. Nieves, None

    N. Ashouri, None

    W. Gornick, None

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