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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)39-43
Number of pages5
JournalPediatric Infectious Disease Journal
DOIs
StateAccepted/In press - 2020

Keywords

  • Enterobacterales infections
  • Gram-negative bacteria
  • children
  • drug resistance
  • epidemiology

ASJC Scopus subject areas

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

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