Latania K Logan1,2, Jared R Rispens1,3, Rachel L Medernach1,3, T Nicholas Domitrovic2,4, Andrea M Hujer2,4, Steven H Marshall2, Susan D Rudin2,4, Nadia K Qureshi5, Xiaotian Zheng6,7, Mary K Hayden3, Robert A Weinstein3,8, Robert A Bonomo2,4,9. 1. From the Division of Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Chicago, IL. 2. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH. 3. Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, IL. 4. Medicine, Case Western Reserve School of Medicine, Cleveland, OH. 5. Division of Infectious Diseases, Department of Pediatrics, Loyola University Medical Center, Maywood, IL. 6. Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 7. Department of Pathology, Northwestern Feinberg School of Medicine, Chicago, IL. 8. Cook County Health and Hospital Systems, Chicago, IL; and. 9. Departments of Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve School of Medicine, Cleveland, OH.
Abstract
BACKGROUND: Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales-(Ent) infections are increasing in pediatrics. Before CTX-M ESBL emerged, the most common infection-associated ESBL genes were TEM and SHV-type ESBLs. We sought to define the current epidemiology of Ent infections in children due to blaTEM and blaSHV (TEM-SHV-Ent). METHODS: A retrospective case-control analysis of children with TEM-SHV-Ent infections at 3 Chicago-area hospitals was performed. Cases had extended-spectrum-cephalosporin (ESC)-resistant infections due to blaTEM or blaSHV. DNA analysis assessed β-lactamase (bla) genes, multilocus sequence types, and E. coli phylogenetic grouping. Controls had ESC-susceptible Ent infections, matched 3:1 to cases by age, source, and hospital. Clinical-epidemiologic infection predictors were assessed. RESULTS: Of 356 ESC-R-Ent isolates from children (median 4.3 years), 38 (10.7%) were positive solely for blaTEM-ESBL (26%) or blaSHV-ESBL genes (74%). Predominant organisms were Klebsiella (34.2%) and E. coli (31.6%); 67% of E. coli were phylogroup B2. Multilocus sequence types revealed multiple strains, 58% resistant to ≥3 antibiotic classes. On multivariable analysis, children with TEM-SHV-Ent infections more often had recent inpatient care (OR, 8.2), yet were diagnosed mostly as outpatients (OR, 25.6) and less in Neonatal Intensive Care Units (OR, 0.036) than controls. TEM-SHV-Ent patients had more gastrointestinal (OR, 23.7) and renal comorbidities (OR, 4.2). Differences in demographics, antibiotic exposure, and foreign bodies were not found. CONCLUSION: TEM-SHV-Ent are commonly linked to inpatient exposures in children with chronic conditions but most often present in outpatient settings. Clinicians should be aware of the potential increased risk for TEM-SHV-Ent infections in outpatients with gastrointestinal and renal comorbidities and histories of prolonged hospital stays.
BACKGROUND: Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales-(Ent) infections are increasing in pediatrics. Before CTX-M ESBL emerged, the most common infection-associated ESBL genes were TEM and SHV-type ESBLs. We sought to define the current epidemiology of Ent infections in children due to blaTEM and blaSHV (TEM-SHV-Ent). METHODS: A retrospective case-control analysis of children with TEM-SHV-Ent infections at 3 Chicago-area hospitals was performed. Cases had extended-spectrum-cephalosporin (ESC)-resistant infections due to blaTEM or blaSHV. DNA analysis assessed β-lactamase (bla) genes, multilocus sequence types, and E. coli phylogenetic grouping. Controls had ESC-susceptible Ent infections, matched 3:1 to cases by age, source, and hospital. Clinical-epidemiologic infection predictors were assessed. RESULTS: Of 356 ESC-R-Ent isolates from children (median 4.3 years), 38 (10.7%) were positive solely for blaTEM-ESBL (26%) or blaSHV-ESBL genes (74%). Predominant organisms were Klebsiella (34.2%) and E. coli (31.6%); 67% of E. coli were phylogroup B2. Multilocus sequence types revealed multiple strains, 58% resistant to ≥3 antibiotic classes. On multivariable analysis, children with TEM-SHV-Ent infections more often had recent inpatient care (OR, 8.2), yet were diagnosed mostly as outpatients (OR, 25.6) and less in Neonatal Intensive Care Units (OR, 0.036) than controls. TEM-SHV-Ent patients had more gastrointestinal (OR, 23.7) and renal comorbidities (OR, 4.2). Differences in demographics, antibiotic exposure, and foreign bodies were not found. CONCLUSION: TEM-SHV-Ent are commonly linked to inpatient exposures in children with chronic conditions but most often present in outpatient settings. Clinicians should be aware of the potential increased risk for TEM-SHV-Ent infections in outpatients with gastrointestinal and renal comorbidities and histories of prolonged hospital stays.
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: Danielle M Zerr; Xuan Qin; Assaf P Oron; Amanda L Adler; Daniel J Wolter; Jessica E Berry; Lucas Hoffman; Scott J Weissman Journal: Antimicrob Agents Chemother Date: 2014-05-05 Impact factor: 5.191
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