Methods: A case-control study of children (0-18 years) cared for by 3 Chicago hospitals during 2011-16 was performed. Cases were 38 children with infections due to Ent harboring a lone TEM- or SHV-type ESBL as detected by DNA microarray (Check-Points®). PCR, DNA sequencing, Rep-PCR, plasmid typing, and phylogenetic grouping were also performed. Controls (ctrls) were 137 children with 3rd generation cephalosporin susceptible Ent infections matched by age and hospital. Demographics; patient residence; comorbidities; device, antibiotic, and healthcare exposures were evaluated. Bivariate and multivariable logistic regression analyses explored associations between predictors and TEMSHV Ent infection.
Results: Of 38 TEMSHV Ent infections, 74% were SHV-type and 26% TEM-type. The median age of TEMSHV Ent patients was 4.3 (0-17.9) years. Predominant organisms were Klebsiella spp. (34.2%) and E. coli (31.6%); 67% of E. coli were phylogroup B2. Most strains were unrelated; 47% were MDRO. On bivariate analysis, TEMSHV Ent patients were more likely to be male (53% vs. 34%, p=0.04), have longer LOS after infection (35d vs. 14d, p<0.001) but no difference in mortality, and have less UTIs (53% vs. 75%, p=0.01) than ctrls. On multivariable analysis, children with TEMSHV Ent infections more often had recent inpatient care (OR 8.2), yet were diagnosed more frequently as outpatients (OR 25.6) and less often in NICUs (OR 0.036) than ctrls. TEMSHV Ent patients had more gastrointestinal (GI) (OR 23.7) and renal comorbidities (OR 4.2) vs. ctrls. Differences in race, gender, residential neighborhood, antibiotic exposure, and foreign bodies were not significant after controlling for other factors.
Conclusion: In children, factors associated with TEMSHV Ent infections include recent inpatient care and GI and renal comorbidities. Infections are associated with longer LOS but not greater mortality. Control of TEMSHV Ent infections in children should focus on validating and responding to these risk factors.
J. R. Rispens,
A. M. Hujer, None
T. N. Domitrovic, None
S. H. Marshall, None
S. D. Rudin, None
X. Zheng, None
N. K. Qureshi, None
M. K. Hayden, Sage, Inc: Sage is contributing product to healthcare facilities participating in a regional collaborative on which I am a co-investigator. Neither I nor my hospital receive product. , Sage is contributing product to healthcare facilities participating in a regional collaborative on which I am a co-investigator. Neither I nor my hospital receive product.
Clorox, Inc.: I have received funding from Clorox for an investigator-initiated clinical trial. , Research support
CDC: Grant Investigator , Research grant
OpGen: receipt of in kind laboratory services , Research support
R. A. Weinstein, None
R. A. Bonomo, Merck: Grant Investigator and Investigator , Consulting fee and Research support
Allergan: Grant Investigator , Research support
Wockhardt: Grant Investigator , Research support
Glaxo Smith Kline: Grant Investigator , Research support
Astra Zeneca: Grant Investigator , Research support
Actavis: Speaker's Bureau , Speaker honorarium
L. K. Logan, None