title: Community-Onset Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France.
abstract: Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.
authors.affiliation: From the Department of General Pediatrics and Pediatric Infectious Disease (JT, MG, MC); Department of Pediatric Emergency (ST); Department of Microbiology (AF, XN, J-RZ); Department of Infectious Diseases and Tropical Medicine (OL), Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université Paris Descartes, IHU Imagine, Paris; and Unité de Prévention et de Lutte contre les Infections Nosocomiales (J-RZ), CHU d'Angers, Université d'Angers, Angers, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Toubiana
authors.forename: Sandra
authors.initials: S
authors.lastname: Timsit
authors.forename: Agnès
authors.initials: A
authors.lastname: Ferroni
authors.forename: Marie
authors.initials: M
authors.lastname: Grasseau
authors.forename: Xavier
authors.initials: X
authors.lastname: Nassif
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology*; D004351:Drug Resistance; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000472:pathogenicity*; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000382:microbiology; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000382:microbiology; D008297:Male; D018410:Pneumonia, Bacterial / Q000382:microbiology; D011379:Prognosis; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000382:microbiology; D014774:Virulence; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases