Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Infections in Children: A Two-Center Case-Case-Control Study of Risk Factors and Outcomes in Chicago, Illinois

Latania K Logan; Laura A Meltzer; James B McAuley; Mary K Hayden; Todd Beck; Nikolay P Braykov; Ramanan Laxminarayan; Robert A Weinstein; CDC Epicenters Prevention Program

doi:10.1093/jpids/piu011

Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Infections in Children: A Two-Center Case-Case-Control Study of Risk Factors and Outcomes in Chicago, Illinois

J Pediatric Infect Dis Soc. 2014 Dec;3(4):312-9. doi: 10.1093/jpids/piu011. Epub 2014 Mar 19.

Authors

Latania K Logan¹, Laura A Meltzer², James B McAuley³, Mary K Hayden⁴, Todd Beck⁵, Nikolay P Braykov⁶, Ramanan Laxminarayan⁷, Robert A Weinstein⁸; CDC Epicenters Prevention Program

Affiliations

¹ Departments of Pediatrics Section of Pediatric Infectious Diseases John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
² Departments of Pediatrics.
³ Departments of Pediatrics Section of Pediatric Infectious Diseases.
⁴ Internal Medicine, Division of Infectious Diseases.
⁵ Rush Institute for Healthy Aging, Rush University Medical Center, Rush Medical College, Chicago, Illinois.
⁶ Center for Disease Dynamics, Economics and Policy, Washington, DC.
⁷ Center for Disease Dynamics, Economics and Policy, Washington, DC Public Health Foundation of India, New Delhi, India Princeton University, New Jersey.
⁸ Internal Medicine, Division of Infectious Diseases John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.

PMID: 26625451
DOI: 10.1093/jpids/piu011

Abstract

Background: Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae infections are an emerging problem in children. We sought to identify risk factors and describe outcomes associated with pediatric ESBL-producing bacterial infections at 2 hospitals in Chicago, IL from 2008 to 2011.

Methods: A case-case-control study of children aged 0-17 years was conducted. Cases of Escherichia coli, Klebsiella, and Proteus spp. ESBL-producing bacterial infections (n = 30) were compared to uninfected controls and in parallel, cases of non-ESBL-producing bacterial infections (n = 30) were compared to uninfected controls (n = 60). We then qualitatively compared these results.

Results: Median age of cases was 1.06 years; 62% of isolates were from urine, and 60% were E. coli. By multivariable analysis, ESBL cases were 5.7 and 3.3 times more likely to have gastrointestinal (P = .001; 95% confidence interval [CI] 1.9-17.0) and neurologic (P = .001; 95% CI 1.1-3.7) comorbidities, respectively, than controls; non-ESBL cases were also more likely to have gastrointestinal comorbidities than controls (P = .014; odds ratio 3.6; 95% CI 1.2-10.1). Study period prevalence remained stable (1.7%). Most (60%) infections occurred in the intensive care unit; however, 30% of children presented in the outpatient setting. Seventy-seven percent of isolates were multidrug resistant (ie, resistant to ≥3 antibiotic classes). Recurrence of infection occurred in 17% of ESBL cases. Crude mortality rates (7%) did not differ between cases and controls.

Conclusions: The incidence of pediatric infection due to ESBL-positive Enterobacteriaceae was stable at 2 large tertiary-care medical centers over a 4-year period. Multidrug resistance in pediatric ESBL isolates is common. Risk factors for infection due to ESBL-producing bacteria include neurologic medical conditions.

Keywords: antibacterial agents; child; drug resistance; enterobacteriaceae infections; epidemiology; β-lactamases.

Publication types

Research Support, Non-U.S. Gov't