A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children

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

doi:10.1097/INF.0000000000002916

A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children

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

^*Corresponding author for this work

Pathology

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

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 bla_TEMand bla_SHV(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 bla_TEMor bla_SHV. 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 bla_TEM-ESBL(26%) or bla_SHV-ESBLgenes (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.

Original language	English (US)
Pages (from-to)	39-43
Number of pages	5
Journal	Pediatric Infectious Disease Journal
Volume	40
Issue number	1
DOIs	https://doi.org/10.1097/INF.0000000000002916
State	Published - Jan 1 2021

Funding

Supported by National Institutes of Health—National Institute of Allergy and Infectious Diseases grant K08AI112506 (L.K.L.) and grants R01AI072219, R01AI063517, and R01AI100560 (R.A.B.). This work was also supported by the Department of Veterans Affairs Research and Development under award number I01BX001974, VISN 10 Geriatrics Research, Education, and Clinical Center (R.A.B.). We gratefully acknowledge the contribution of the late Dr. Paul Schreckenberger to this work. We thank the microbiology laboratories of the participating institutions for providing isolates for this study. We thank Kendrick Reme of the Logan Laboratory and Diane Springer, Joyce Houlihan, Kathleen McKinley, Violeta Rekasiu, Cindy Bethel, and Donna Carter of participating institutions for collection, shipping, and cultivation of organisms. We thank the team of curators of the Institut Pasteur MLST and whole-genome MLST databases for curating the data and making them publicly available at http://bigsdb.web.pasteur.fr/. This publication also made use of the Enterobacter cloacae MLST website (https:// pubmlst.org/ecloacae/) sited at the University of Oxford. The development of the pubmlst.org site has been funded by the Wellcome Trust. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Veterans Affairs.

Keywords

Enterobacterales infections
Gram-negative bacteria
children
drug resistance
epidemiology

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases
Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/INF.0000000000002916

Cite this

Logan, L. K., Rispens, J. R., Medernach, R. L., Domitrovic, T. N., Hujer, A. M., Marshall, S. H., Rudin, S. D., Qureshi, N. K., Zheng, X., Hayden, M. K., Weinstein, R. A., & Bonomo, R. A. (2021). A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children. Pediatric Infectious Disease Journal, 40(1), 39-43. https://doi.org/10.1097/INF.0000000000002916

@article{8df4363ee4dc4f60add92b0f7a5d386a,

title = "A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children",

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 blaTEMand 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 blaTEMor 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-ESBLgenes (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.",

keywords = "Enterobacterales infections, Gram-negative bacteria, children, drug resistance, epidemiology",

author = "Logan, {Latania K.} and Rispens, {Jared R.} and Medernach, {Rachel L.} and Domitrovic, {T. Nicholas} and Hujer, {Andrea M.} and Marshall, {Steven H.} and Rudin, {Susan D.} and Qureshi, {Nadia K.} and Xiaotian Zheng and Hayden, {Mary K.} and Weinstein, {Robert A.} and Bonomo, {Robert A.}",

year = "2021",

month = jan,

day = "1",

doi = "10.1097/INF.0000000000002916",

language = "English (US)",

volume = "40",

pages = "39--43",

journal = "Pediatric Infectious Disease Journal",

issn = "0891-3668",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Logan, LK, Rispens, JR, Medernach, RL, Domitrovic, TN, Hujer, AM, Marshall, SH, Rudin, SD, Qureshi, NK, Zheng, X, Hayden, MK, Weinstein, RA & Bonomo, RA 2021, 'A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children', Pediatric Infectious Disease Journal, vol. 40, no. 1, pp. 39-43. https://doi.org/10.1097/INF.0000000000002916

A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children. / Logan, Latania K.; Rispens, Jared R.; Medernach, Rachel L. et al.
In: Pediatric Infectious Disease Journal, Vol. 40, No. 1, 01.01.2021, p. 39-43.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children

AU - Logan, Latania K.

AU - Rispens, Jared R.

AU - Medernach, Rachel L.

AU - Domitrovic, T. Nicholas

AU - Hujer, Andrea M.

AU - Marshall, Steven H.

AU - Rudin, Susan D.

AU - Qureshi, Nadia K.

AU - Zheng, Xiaotian

AU - Hayden, Mary K.

AU - Weinstein, Robert A.

AU - Bonomo, Robert A.

PY - 2021/1/1

Y1 - 2021/1/1

N2 - 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 blaTEMand 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 blaTEMor 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-ESBLgenes (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.

AB - 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 blaTEMand 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 blaTEMor 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-ESBLgenes (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.

KW - Enterobacterales infections

KW - Gram-negative bacteria

KW - children

KW - drug resistance

KW - epidemiology

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U2 - 10.1097/INF.0000000000002916

DO - 10.1097/INF.0000000000002916

M3 - Article

C2 - 33021591

AN - SCOPUS:85097576034

SN - 0891-3668

VL - 40

SP - 39

EP - 43

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

IS - 1

ER -

A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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