Background: Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae infections are increasing in the pediatric population. International travel has been identified as a risk factor for ESBL in adult patients. The aim of this study was to describe the epidemiology of ESBL in children, to determine what proportion of ESBL episodes were community onset, and to identify risk factors that predispose children to ESBL.
Methods: A retrospective, case-case-control study of children aged 0-18 years was conducted from 2012-2014. ESBLs were detected via VITEK2. Patients with ESBL were compared to patients with non-ESBL Enterobacteriaceae infections (n=76 each) and were matched 1:1:5 to uninfected controls (n=380), by age, sex, specimen source, and healthcare setting. Data on prior antibiotic and healthcare exposure in past 30 days, international travel in past 6 months, prior urinary tract infection (UTI), comorbid gastrointestinal (GI), genitourinary (GU), neurologic, and immunocompromising conditions were collected. Community onset was defined as culture obtained <2 days after hospitalization or presentation to care.
Results: A total of 76 patients were identified with 85 ESBL episodes, of which 91% were E. coli, 7% K. pneumoniae, and 2% K. oxytoca. ESBL was isolated most frequently from urine (85%). Most episodes were community onset (89%) and managed in the outpatient/ED setting (58%). Resistance to nitrofurantoin, ciprofloxacin and trimethoprim-sulfamethoxazole was detected in 22%, 53%, and 62% of ESBL isolates, respectively. On univariate analysis, comorbid GU and GI conditions, prior UTI, and international travel were significant risk factors for ESBL compared to the non-ESBL and uninfected control groups. On multivariate analysis, only international travel (p< 0.001, OR 8.93; 95% CI 2.92-27.78), comorbid GI condition (p= 0.002, OR 2.65, 95% CI 1.36-5.15), and prior UTI (p <0.001, OR 8.06, CI 3.47-18.87) remained as significant risk factors for ESBL. Healthcare or antibiotic exposure in the past 30 days were not significant.
Conclusion: The majority of ESBL episodes were community onset and were managed in the outpatient setting. Risk factors for ESBL included international travel, the presence of a GI comorbidity, and prior UTI.
J. Cleveland, None
H. Siddiqui, None
P. Homel, None
C. Gagliardo, None
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