title: The contribution of extended-spectrum β-lactamases to multidrug-resistant infections in children.
abstract: OBJECTIVE
  The prevalence of multidrug-resistant (MDR) infections caused by Gram-negative rods (GNRs) such as Escherichia coli and Klebsiella pneumoniae is increasing in large part because of the production of extended-spectrum β-lactamases (ESBLs) that confer resistance to third-generation cephalosporins such as ceftriaxone. This review examines the clinical implication of changes in the epidemiology, diagnostic tools, and reporting criteria for ESBL-GNRs.
  
  
  RESULTS
  Pediatric ESBL-GNR infections, once associated only with hospitals, are increasing in the community. The most common risk factor for ESBL-GNR infection is previous antibiotic use. Evidence also exists for prolonged fecal carriage after discharge from neonatal ICUs, leading to community transmission with close contact of known carriers. Controversial changes in the laboratory criteria for GNR cephalosporin resistance have also contributed to the increased numbers of reported MDR-GNR infections. Newer diagnostic tools will enable more rapid identification of MDR-GNR infections, leading to earlier implementation of appropriate therapy.
  
  
  CONCLUSIONS
  ESBL-GNR infections are no longer limited to ICUs and are now being identified in children presenting from the community. Appropriate antibiotic prescribing practices are critical to limit the spread of ESBL-GNRs, and pediatricians must prepare to identify and treat these challenging infections.
authors.affiliation: aDepartment of Medical Science, Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut bDepartment of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut cLaboratory Medicine Services, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Murray
authors.forename: David R
authors.initials: DR
authors.lastname: Peaper
mesh_terms: D000900:Anti-Bacterial Agents; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection; D018432:Drug Resistance, Multiple / Q000276:immunology*; D004926:Escherichia coli / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D018440:beta-Lactam Resistance / Q000276:immunology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases