title: Epidemiology and Burden of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal.
abstract: BACKGROUND
  Severe bacterial infections are not considered as a leading cause of death in young children in sub-Saharan Africa. The worldwide emergence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) could change the paradigm, especially in neonates who are at high risk of developing healthcare-associated infections.
  
  
  OBJECTIVE
  To evaluate the epidemiology and the burden of ESBL-E bloodstream infections (BSI).
  
  
  METHODS
  A case-case-control study was conducted in patients admitted in a pediatric hospital during two consecutive years. Cases were patients with Enterobacteriaceae BSI and included ESBL-positive (cases 1) and ESBL-negative BSI (cases 2). Controls were patients with no BSI. Multivariate analysis using a stepwise logistic regression was performed to identify risk factors for ESBL acquisition and for fatal outcomes. A multistate model was used to estimate the excess length of hospital stay (LOS) attributable to ESBL production while accounting for time of infection. Cox proportional hazards models were performed to assess the independent effect of ESBL-positive and negative BSI on LOS.
  
  
  RESULTS
  The incidence rate of ESBL-E BSI was of 1.52 cases/1000 patient-days (95% CI: 1.2-5.6 cases per 1000 patient-days). Multivariate analysis showed that independent risk factors for ESBL-BSI acquisition were related to underlying comorbidities (sickle cell disease OR = 3.1 (95%CI: 2.3-4.9), malnutrition OR = 2.0 (95%CI: 1.7-2.6)) and invasive procedures (mechanical ventilation OR = 3.5 (95%CI: 2.7-5.3)). Neonates were also identified to be at risk for ESBL-E BSI. Inadequate initial antibiotic therapy was more frequent in ESBL-positive BSI than ESBL-negative BSI (94.2% versus 5.7%, p<0.0001). ESBL-positive BSI was associated with higher case-fatality rate than ESBL-negative BSI (54.8% versus 15.4%, p<0.001). Multistate modelling indicated an excess LOS attributable to ESBL production of 4.3 days. The adjusted end-of-LOS hazard ratio for ESBL-positive BSI was 0.07 (95%CI, 0.04-0.12).
  
  
  CONCLUSIONS
  Control of ESBL-E spread is an emergency in pediatric populations and could be achieved with simple cost-effective measures such as hand hygiene, proper management of excreta and better stewardship of antibiotic use, especially for empirical therapy.
authors: PhD Program, Université Pierre Marie Curie, Paris, France.|Institut Pasteur de Dakar, Dakar, Sénégal.
authors: Awa
authors: A
authors: Ndir
authors: Hôpital pour enfants Albert Royer, Dakar, Sénégal.
authors: Amadou
authors: A
authors: Diop
authors: Hôpital pour enfants Albert Royer, Dakar, Sénégal.
authors: Pape Makhtar
authors: PM
authors: Faye
authors: Hôpital pour enfants Albert Royer, Dakar, Sénégal.
authors: Moussa Fafa
authors: MF
authors: Cissé
authors: National nosocomial infection program, Ministry of Health, Dakar, Sénégal.
authors: Babacar
authors: B
authors: Ndoye
authors: Universités Sorbonne Paris-Cité, Paris, France.
authors: Pascal
authors: P
authors: Astagneau
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000032:analysis* / Q000235:genetics; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004198:Disease Susceptibility; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D012675:Senegal / Q000453:epidemiology; D013379:Substrate Specificity; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000032:analysis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases