2289. A Multicenter Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended- Spectrum Beta-Lactamase producing (ESBL) Enterobacteriaceae (Ent) Infections in Children
Session: Poster Abstract Session: Pediatric Bacterial Infections: From A to Z
Saturday, October 7, 2017
Room: Poster Hall CD
  • Rispens IDweek Poster.pdf (1000.0 kB)
  • Background: ESBL Ent infections are increasingly prevalent in the pediatric population; however, most ESBL Ent studies have focused on adults and/or CTX-M-type strains. We sought to characterize the molecular epidemiology of ESBL Ent strains and to identify factors associated with TEM- and SHV-type ESBL Ent (TEMSHV Ent) infections in children.

    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.

    Jared R. Rispens, M.D.1, Rachel L. Medernach, M.D.2, Andrea M. Hujer, BS3, T. Nicholas Domitrovic, MS4, Steven H. Marshall, MS5, Susan D. Rudin, B.S.6, Xiaotian Zheng, MD, PhD7,8, Nadia K. Qureshi, MD9, Mary K. Hayden, MD, FIDSA, FSHEA10, Robert A. Weinstein, MD, FIDSA, FSHEA11,12, Robert A. Bonomo, MD4,13 and Latania K. Logan, MD, MSc4,14,15, (1)Internal Medicine and Pediatrics, Rush University Medical Center, Chicago, IL, (2)Rush University Medical Center, Chicago, IL, (3)Case Western Reserve University, Cleveland, OH, (4)Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, (5)Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, (6)Research Service, VA Cleveland Medical Center, Cleveland, OH, (7)Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (8)Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, (9)Pediatrics, Loyola University Medical Center, Maywood, IL, (10)Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, (11)John H. Stroger Jr. Hospital of Chicago, Chicago, IL, (12)Internal Medicine, Rush University Medical Center, Chicago, IL, (13)Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, (14)Pediatrics, Rush University Medical Center, Chicago, IL, (15)Rush Medical College, Chicago, IL


    J. R. Rispens, None

    R. L. Medernach, None

    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

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.