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Community-Onset Extended-Spectrum β -Lactamase – Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France

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ABSTRACT

Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.

We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.

No MeSH data available.


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Prevalence of ESBL-PE among Enterobacteriaceae strains. Prevalence of ESBL-PE found in community-, healthcare-associated or all (community + healthcare-associated) infections among Enterobacteriaceae isolates. ∗P for trend < 0.001.ESBL-PE = extended spectrum β-lactamases-producing Enterobacteriaceae.
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Figure 1: Prevalence of ESBL-PE among Enterobacteriaceae strains. Prevalence of ESBL-PE found in community-, healthcare-associated or all (community + healthcare-associated) infections among Enterobacteriaceae isolates. ∗P for trend < 0.001.ESBL-PE = extended spectrum β-lactamases-producing Enterobacteriaceae.

Mentions: During the study period, 3612 Enterobacteriaceae isolates were identified from normally sterile samples from children within the first 48 hours of hospitalization: E coli (81%), Proteus spp. (7%), Klebsiella spp. (6%), and Enterobacter spp. (3%). Species were isolated from urine (91.8%), peritoneal fluid (3.7%), blood (2.1%), deep abscess (2%), and CSF (0.4%). An ESBL-producing strain was identified in 140 isolates (3.9%), with a significant increase from 2007 (2.4%) to 2012 (5.1%) (P < 0.001; Figure 1). The increase was observed for community- and healthcare-associated ESBL-PE infections and mainly concerned 3 species: E coli (1.7–3.7%), K pneumoniae (21.4–31.3%), and Enterobacter spp. (7.7–18.8%). No ESBL-producing Proteus spp. was isolated. ESBL-PE infections were observed in 3.9% (n = 128/3315) of all urinary-infected samples and 4% (n = 12/297) of samples from other sites (12% bloodstream, 1% deep abscesses and peritonitis, and 7% CSF), with a significant increase in ESBL-PE strains during the study period for UTIs from 2007 to 2012 (2.6–5.2%, P < 0.001).


Community-Onset Extended-Spectrum β -Lactamase – Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France
Prevalence of ESBL-PE among Enterobacteriaceae strains. Prevalence of ESBL-PE found in community-, healthcare-associated or all (community + healthcare-associated) infections among Enterobacteriaceae isolates. ∗P for trend < 0.001.ESBL-PE = extended spectrum β-lactamases-producing Enterobacteriaceae.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998397&req=5

Figure 1: Prevalence of ESBL-PE among Enterobacteriaceae strains. Prevalence of ESBL-PE found in community-, healthcare-associated or all (community + healthcare-associated) infections among Enterobacteriaceae isolates. ∗P for trend < 0.001.ESBL-PE = extended spectrum β-lactamases-producing Enterobacteriaceae.
Mentions: During the study period, 3612 Enterobacteriaceae isolates were identified from normally sterile samples from children within the first 48 hours of hospitalization: E coli (81%), Proteus spp. (7%), Klebsiella spp. (6%), and Enterobacter spp. (3%). Species were isolated from urine (91.8%), peritoneal fluid (3.7%), blood (2.1%), deep abscess (2%), and CSF (0.4%). An ESBL-producing strain was identified in 140 isolates (3.9%), with a significant increase from 2007 (2.4%) to 2012 (5.1%) (P < 0.001; Figure 1). The increase was observed for community- and healthcare-associated ESBL-PE infections and mainly concerned 3 species: E coli (1.7–3.7%), K pneumoniae (21.4–31.3%), and Enterobacter spp. (7.7–18.8%). No ESBL-producing Proteus spp. was isolated. ESBL-PE infections were observed in 3.9% (n = 128/3315) of all urinary-infected samples and 4% (n = 12/297) of samples from other sites (12% bloodstream, 1% deep abscesses and peritonitis, and 7% CSF), with a significant increase in ESBL-PE strains during the study period for UTIs from 2007 to 2012 (2.6–5.2%, P < 0.001).

View Article: PubMed Central - PubMed

ABSTRACT

Limited data is available on pediatric community-onset infections with extended-spectrum &beta;-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.

We retrospectively analyzed data from 2007 to 2012 for all children &le;16 years old with a positive ESBL-PE strain from usually sterile sites within 48&#8202;hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P&#8202;&lt;&#8202;0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n&#8202;=&#8202;52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P&#8202;&lt;&#8202;0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.

No MeSH data available.


Related in: MedlinePlus