title: Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Infections in Children: A Two-Center Case-Case-Control Study of Risk Factors and Outcomes in Chicago, Illinois.
abstract: BACKGROUND
  Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae infections are an emerging problem in children. We sought to identify risk factors and describe outcomes associated with pediatric ESBL-producing bacterial infections at 2 hospitals in Chicago, IL from 2008 to 2011.
  
  
  METHODS
  A case-case-control study of children aged 0-17 years was conducted. Cases of Escherichia coli, Klebsiella, and Proteus spp. ESBL-producing bacterial infections (n = 30) were compared to uninfected controls and in parallel, cases of non-ESBL-producing bacterial infections (n = 30) were compared to uninfected controls (n = 60). We then qualitatively compared these results.
  
  
  RESULTS
  Median age of cases was 1.06 years; 62% of isolates were from urine, and 60% were E. coli. By multivariable analysis, ESBL cases were 5.7 and 3.3 times more likely to have gastrointestinal (P = .001; 95% confidence interval [CI] 1.9-17.0) and neurologic (P = .001; 95% CI 1.1-3.7) comorbidities, respectively, than controls; non-ESBL cases were also more likely to have gastrointestinal comorbidities than controls (P = .014; odds ratio 3.6; 95% CI 1.2-10.1). Study period prevalence remained stable (1.7%). Most (60%) infections occurred in the intensive care unit; however, 30% of children presented in the outpatient setting. Seventy-seven percent of isolates were multidrug resistant (ie, resistant to ≥3 antibiotic classes). Recurrence of infection occurred in 17% of ESBL cases. Crude mortality rates (7%) did not differ between cases and controls.
  
  
  CONCLUSIONS
  The incidence of pediatric infection due to ESBL-positive Enterobacteriaceae was stable at 2 large tertiary-care medical centers over a 4-year period. Multidrug resistance in pediatric ESBL isolates is common. Risk factors for infection due to ESBL-producing bacteria include neurologic medical conditions.
authors.affiliation: Departments of Pediatrics Section of Pediatric Infectious Diseases John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
authors.forename: Latania K
authors.initials: LK
authors.lastname: Logan
authors.affiliation: Departments of Pediatrics.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Meltzer
authors.affiliation: Departments of Pediatrics Section of Pediatric Infectious Diseases.
authors.forename: James B
authors.initials: JB
authors.lastname: McAuley
authors.affiliation: Internal Medicine, Division of Infectious Diseases.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
authors.affiliation: Rush Institute for Healthy Aging, Rush University Medical Center, Rush Medical College, Chicago, Illinois.
authors.forename: Todd
authors.initials: T
authors.lastname: Beck
authors.affiliation: Center for Disease Dynamics, Economics and Policy, Washington, DC.
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Braykov
authors.affiliation: Center for Disease Dynamics, Economics and Policy, Washington, DC Public Health Foundation of India, New Delhi, India Princeton University, New Jersey.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
authors.affiliation: Internal Medicine, Division of Infectious Diseases John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
keywords: antibacterial agents; child; drug resistance; enterobacteriaceae infections; epidemiology; β-lactamases