title: Pediatric infection and intestinal carriage due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae.
abstract: The objective of this study is to describe the epidemiology of intestinal carriage with extended-spectrum-cephalosporin-resistant Enterobacteriaceae in children with index infections with these organisms. Patients with resistant Escherichia coli or Klebsiella bacteria isolated from the urine or a normally sterile site between January 2006 and December 2010 were included in this study. Available infection and stool isolates underwent phenotypic and molecular characterization. Clinical data relevant to the infections were collected and analyzed. Overall, 105 patients were identified with 106 extended-spectrum-cephalosporin-resistant E. coli (n = 92) or Klebsiella (n = 14) strains isolated from urine or a sterile site. Among the 27 patients who also had stool screening for resistant Enterobacteriaceae, 17 (63%) had intestinal carriage lasting a median of 199 days (range, 62 to 1,576). There were no significant differences in demographic, clinical, and microbiological variables between those with and those without intestinal carriage. Eighteen (17%) patients had 37 subsequent resistant Enterobacteriaceae infections identified: 31 urine and 6 blood. In a multivariable analysis, antibiotic intake in the 91 days prior to subsequent urine culture was significantly associated with subsequent urinary tract infection with a resistant organism (hazard ratio, 14.3; 95% confidence interval [CI], 1.6 to 130.6). Intestinal carriage and reinfection were most commonly due to bacterial strains of the same sequence type and with the same resistance determinants as the index extended-spectrum-cephalosporin-resistant Enterobacteriaceae, but carriage and reinfection with different resistant Enterobacteriaceae strains also occurred.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA Seattle Children's Hospital Research Institute, Seattle, Washington, USA danielle.zerr@seattlechildrens.org.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
authors.affiliation: Seattle Children's Hospital Research Institute, Seattle, Washington, USA Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Xuan
authors.initials: X
authors.lastname: Qin
authors.affiliation: Seattle Children's Hospital Research Institute, Seattle, Washington, USA.
authors.forename: Assaf P
authors.initials: AP
authors.lastname: Oron
authors.affiliation: Seattle Children's Hospital Research Institute, Seattle, Washington, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Adler
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wolter
authors.affiliation: Seattle Children's Hospital Research Institute, Seattle, Washington, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Berry
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA Seattle Children's Hospital Research Institute, Seattle, Washington, USA Department of Microbiology, University of Washington, Seattle, Washington, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Hoffman
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA Seattle Children's Hospital Research Institute, Seattle, Washington, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Weissman
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy* / Q000382:microbiology*; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007422:Intestines / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004269:DNA, Bacterial; D001618:beta-Lactamases