TY - JOUR
T1 - Community origins and regional differences highlight risk of plasmid-mediated fluoroquinolone resistant enterobacteriaceae infections in children
AU - Logan, Latania K.
AU - Medernach, Rachel L.
AU - Rispens, Jared R.
AU - Marshall, Steven H.
AU - Hujer, Andrea M.
AU - Domitrovic, T. Nicholas
AU - Rudin, Susan D.
AU - Zheng, Xiaotian
AU - Qureshi, Nadia K.
AU - Konda, Sreenivas
AU - Hayden, Mary K.
AU - Weinstein, Robert A.
AU - Bonomo, Robert A.
N1 - Funding Information:
From the *Pediatrics, Rush University Medical Center, Chicago, Illinois; †Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; ‡University of Illinois at Chicago, §Cook County Health and Hospital Systems, and ¶Medicine, Rush University Medical Center, Chicago, Illinois; ║Department of Pharmacology, Molecu-lar Biology, Microbiology and Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio; **Microbiology, Ann & Robert H. Lurie Chil-dren’s Hospital of Chicago, and ††Pathology, Northwestern Feinberg School of Medicine, Chicago, Illinois; ‡‡Pediatrics, Loyola University Medical Center, Maywood, Illinois; and §§Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve School of Medicine, Cleveland, Ohio. 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.). 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.).
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Background: Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children. Methods: A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin- resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. Results: Of 169 third-generation cephalosporin-resistant and/or carbapenem- resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found. Conclusions: The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
AB - Background: Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children. Methods: A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin- resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. Results: Of 169 third-generation cephalosporin-resistant and/or carbapenem- resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found. Conclusions: The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
KW - Children
KW - Drug resistance
KW - Enterobacteriaceae infections
KW - Epidemiology
KW - Gram-negative bacteria
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U2 - 10.1097/INF.0000000000002205
DO - 10.1097/INF.0000000000002205
M3 - Article
C2 - 30281548
AN - SCOPUS:85065859513
SN - 0891-3668
VL - 38
SP - 595
EP - 599
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 6
ER -
