The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

Infectious Diseases and Therapy

Sreenivas Konda¹  Robert A. Weinstein²  Xiaotian Zheng³  Nadia K. Qureshi⁴  Latania K. Logan⁵  David C. Nguyen⁵  Rachel L. Medernach⁵  Jared R. Rispens⁵  T. Nicholas Domitrovic⁶  Robert A. Bonomo⁶  Susan D. Rudin⁶  Steven H. Marshall⁶  Andrea M. Hujer⁶ 

[1] Epidemiology and Biostatistics, University of Illinois at Chicago;Medicine, Rush University Medical Center, Rush Medical College;Microbiology, Ann and Robert H. Lurie Children’s Hospital of Chicago;Pediatrics, Loyola University Medical Center;Pediatrics, Rush University Medical Center, Rush Medical College;Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center;

关键词: Children;    Drug resistance;    Enterobacteriaceae infections;    Epidemiology;    Gram-negative bacteria;   

DOI  :  10.1007/s40121-019-0237-2

来源: DOAJ

【 摘 要 】

Abstract Introduction The pandemic of extended-spectrum beta-lactamase-(ESBL)-producing Enterobacteriaceae (Ent) is strongly linked to the dissemination of CTX-M-type-ESBL-Ent. We sought to define the epidemiology of infections in children due to an emerging resistance type, CTX-M-9-group-producing-Ent (CTX-M-9-grp-Ent). Methods A retrospective matched case-control analysis of children with CTX-M-9-grp-Ent infections who received medical care at three Chicago area hospitals was performed. Cases were defined as children possessing extended-spectrum cephalosporin-resistant (ESC-R) infections due to bla CTX-M-9. PCR and DNA analysis assessed beta-lactamase (bla) genes, multi-locus sequence types (MLST) and phylogenetic grouping of E. coli. Controls were children with ESC-susceptible (ESC-S)-Ent infections matched one case to three controls by age, source, and hospital. The clinical-epidemiologic predictors of CTX-M-9-grp-Ent infection were assessed. Results Of 356 ESC-R-Ent isolates from children (median age 4.1 years), the CTX-M-9-group was the solely detected bla gene in 44 (12.4%). The predominant species was E. coli (91%) of virulent phylogroups D (60%) and B2 (40%). MLST revealed multiple strain types. On multivariable analysis, CTX-M-9-grp-Ent occurred more often in E. coli than other Ent genera (OR 7.4, 95% CI 2.4, 27.2), children of non-Black-White-Hispanic race (OR 7.4, 95% CI 2.4, 28.2), and outpatients (OR 4.5, 95% CI 1.7, 12.3), which was a very unexpected finding for infections due to antibiotic-resistant bacteria. Residents of South Chicago had a 6.7 times higher odds of having CTX-M-9-grp-Ent infections than those in the reference region (West), while residence in Northwestern Chicago was associated with an 81% decreased odds of infection. Other demographic, comorbidity, invasive-device, and antibiotic use differences were not found. Conclusion CTX-M-9-grp-Ent infection may be associated with patient residence and is occurring in children without traditional in-patient exposure risk factors. This suggests that among children, the community environment may be a key contributor in the spread of these resistant pathogens.

【 授权许可】

Unknown