73. Antibiotic-Resistant Enterobacteriaceae Colonization in Healthy U.S. Children
Session: Oral Abstract Session: Pediatric Bacterial Infections and Colonization
Thursday, October 8, 2015: 8:30 AM
Room: 32--ABC
Background:  Infections caused by extended-spectrum β-lactamase-producing (ESBL-P) and other antibiotic-resistant Enterobacteriaceae, which are increasing in various pediatric settings, are typically preceded by asymptomatic intestinal carriage. In this multi-center study we examine the epidemiology of antibiotic-resistant Escherichia coli (E. coli) colonization in healthy US children, which to date has not been well characterized.

Methods: Healthy children between 14 days and 11 years of age were enrolled during well- child visits in Oakland, Kansas City, and Nashville, between 12/2013 and 3/2015. Recent antibiotic use in the child and travel and hospitalization history of all members of the subject’s household were queried in a brief risk factor survey. Stool specimens collected from subjects were screened for ESBL-P bacteria using CHROMagarTMESBL media. Confirmation of antibiotic-resistance patterns of putative ESBL-P bacterial colonies was performed by double-disc synergy testing on Mueller-Hinton agar following standard guidelines.  Bacterial identification was confirmed by MALDI-TOF mass spectrometry.

Results: Stool specimens were collected from 520 enrollees. Overall, 3rd generation cephalosporin-resistant E.coli (3GC-R Ec) carriage was 4.2% and ranged from 3.4% to 5.1% among the study sites. 3GC-R Ec carriage was 5.2% in children <5 years of age vs. 2.2% in those ≥5 years (p=0.14). In Oakland, 50% of 3GC-R Ec carriers had a household (HH) member who travelled internationally in the last year compared to 11% of non-carriers (p=0.05). International travel at the other 2 sites was infrequent at 3.6%; overall, 18.2% of 3GC-R Ec carriers vs. 6.1% of non-carriers had a HH member who travelled internationally (p=0.07). No other assessed risk factor approached significance. ESBL production was confirmed in 83% of 3GC-R Ec (3.5% of all enrollees).

Conclusion: 3GC-R Ec intestinal isolates, including ESBL-P, were found in 4% of healthy US children. Younger age and international travel among household members increased the risk of 3GC-R Ec carriage, whereas healthcare-related exposures did not. These findings support that 3GC-R Ec dissemination may occur at the community and global level.

Shamim Islam, MD, DTM&H1, Rangaraj Selvarangan, PhD2, Rajvir Chohan, BA3, James D. Chappell, MD, PhD4, Rendie Mchenry, MS5, Ashveena Dighe, MS, MPH6, Neena Kanwar, PhD7, Natasha Halasa, MD, MPH, FPIDS8, Mary E. Wikswo, MPH9, Daniel Payne, PhD, MSPH9, Parvin H. Azimi, MD10 and Oscar Gomez-Duarte, MD, PHD11, (1)University at Buffalo, State University of New York, Buffalo, NY, (2)Children's Mercy Hosp & Univ MO Kansas City Sch of Med, Kansas City, MO, (3)Infectious Diseases, UCSF Benioff Children's Hospital Oakland, Oakland, CA, (4)Vanderbilt University School of Medicine, Department of Pathology, Nashville, TN, (5)Vanderbilt University, Nashville, TN, (6)University of Washington, Seattle, WA, (7)Children's Mercy Hospital, Kansas City, MO, (8)School of Medicine, Vanderbilt University, Nashville, TN, (9)Centers for Disease Control and Prevention, Atlanta, GA, (10)Children's Hospital, Oakland, CA, (11)Pediatrics, Vanderbilt University School of Medicine, Nashville, TN


S. Islam, None

R. Selvarangan, None

R. Chohan, None

J. D. Chappell, None

R. Mchenry, None

A. Dighe, None

N. Kanwar, None

N. Halasa, Sanofi Pasteur: Grant Investigator , Grant recipient , Research grant and Research support
Gilead: Grant Investigator , Research support
Pfizer: Grant Investigator , Grant recipient , Research grant and Research support
Baxter: Grant Investigator , Grant recipient , Research grant and Research support
Biocryst: Grant Investigator , Research support

M. E. Wikswo, None

D. Payne, None

P. H. Azimi, None

O. Gomez-Duarte, None

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