Latania K Logan1,2,3,4, Rachel L Medernach1,5, Jared R Rispens1,5, Steven H Marshall2, Andrea M Hujer2,6, T Nicholas Domitrovic2,6, Susan D Rudin2,6, Xiaotian Zheng7,8, Nadia K Qureshi9, Sreenivas Konda3, Mary K Hayden5, Robert A Weinstein4,5, Robert A Bonomo2,6,10. 1. From the Pediatrics, Rush University Medical Center, Chicago, Illinois. 2. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio. 3. University of Illinois at Chicago. 4. Cook County Health and Hospital Systems. 5. Medicine, Rush University Medical Center, Chicago, Illinois. 6. Department of Pharmacology, Molecular Biology, Microbiology and Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio. 7. Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago. 8. Pathology, Northwestern Feinberg School of Medicine, Chicago, Illinois. 9. Pediatrics, Loyola University Medical Center, Maywood, Illinois. 10. Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve School of Medicine, Cleveland, Ohio.
Abstract
BACKGROUND: Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children. METHODS: A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. RESULTS: Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found. CONCLUSIONS: The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
BACKGROUND:Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children. METHODS: A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. RESULTS: Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found. CONCLUSIONS: The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
Authors: Pierre Bogaerts; Andrea M Hujer; Thierry Naas; Roberta Rezende de Castro; Andrea Endimiani; Patrice Nordmann; Youri Glupczynski; Robert A Bonomo Journal: Antimicrob Agents Chemother Date: 2011-07-11 Impact factor: 5.191
Authors: Latania K Logan; Nikolay P Braykov; Robert A Weinstein; Ramanan Laxminarayan Journal: J Pediatric Infect Dis Soc Date: 2014-03-19 Impact factor: 3.164
Authors: Andrea Endimiani; Andrea M Hujer; Federico Perez; Christopher R Bethel; Kristine M Hujer; Jennifer Kroeger; Margret Oethinger; David L Paterson; Mark D Adams; Michael R Jacobs; Daniel J Diekema; Gerri S Hall; Stephen G Jenkins; Louis B Rice; Fred C Tenover; Robert A Bonomo Journal: J Antimicrob Chemother Date: 2009-01-20 Impact factor: 5.790
Authors: Michael Y Lin; Rosie D Lyles-Banks; Karen Lolans; David W Hines; Joel B Spear; Russell Petrak; William E Trick; Robert A Weinstein; Mary K Hayden Journal: Clin Infect Dis Date: 2013-08-14 Impact factor: 9.079
Authors: Latania K Logan; Liqing Zhang; Stefan J Green; Samuel Dorevitch; Gustavo A Arango-Argoty; Kendrick Reme; Emily Garner; Jared Aldstadt; Yvette J Johnson-Walker; Mary K Hayden; Robert A Weinstein; Amy Pruden Journal: Antimicrob Agents Chemother Date: 2020-03-24 Impact factor: 5.191
Authors: Latania K Logan; Jared R Rispens; Rachel L Medernach; T Nicholas Domitrovic; Andrea M Hujer; Steven H Marshall; Susan D Rudin; Nadia K Qureshi; Xiaotian Zheng; Mary K Hayden; Robert A Weinstein; Robert A Bonomo Journal: Pediatr Infect Dis J Date: 2021-01 Impact factor: 3.806