title: Extended-Spectrum Beta Lactamase-producing Enterobacteriaceae among the pediatric population: who is at risk and why? Results from a single-centre prospective study.
abstract: A prospective 18-month case-control study was performed in a tertiary Paediatric Centre in Turin (Italy) to analyse the disease burden and identify risk factors for acquisition of Extended Spectrum Beta Lactamase-producing Enterobacteriaceae (ESBL-pE). Children with ESBL-pE isolation were enrolled as cases, with controls matched according to age, type of pathogen isolated and sample of isolation. Out of 83 children (37 males, mean age 4.7 ± 5.46 years), 45 were identified as infected (54.2%) and 38 as colonised (45.8%) by ESBL-pE. Twenty-nine (64.4%) infectious disease episodes were categorised as community-acquired, 16 (35.6%) as healthcare-associated. Escherichia coli was the most frequently isolated pathogen (52, 62.7%) and the urinary tract the most frequent site involved (26, 57.9%). No deaths occurred, even in bloodstream infection cases. Hospitalisation and exposure to broad-spectrum penicillins and III/IV generation cephalosporins in the 90-day period before bacteria isolation were found to be independent risk factors at multivariate analysis. Immunodepression, prolonged central venous catheter (CVC) and urine catheter stay, and receiving a total parenteral nutrition (TPN) in the previous 30 days were otherwise recognized as potential risk factors at univariated analysis. ESBL-producing Enterobacteriaceae infections are a growing threat even in children. Careful recognition of patients at risk should promote targeted interventions in order to reduce the ESBL burden.
authors.affiliation: Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy.
authors.forename: Carmelina
authors.initials: C
authors.lastname: Calitri
authors.affiliation: Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Scolfaro
authors.affiliation: Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Colombo
authors.affiliation: Microbiology Laboratory, Regina Margherita Children's Hospital and Sant'Anna Hospital, A.O.U. Cittá della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: De Intinis
authors.affiliation: Oncohematological Department, Regina Margherita Children's Hospital, A.O.U. Cittá della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Carraro
authors.affiliation: Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Garazzino
authors.affiliation: Department of Paediatrics, Infectious Diseases Unit, University of Turin, Turin, Italy.
authors.forename: Pier-Angelo
authors.initials: PA
authors.lastname: Tovo
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000201:enzymology; D004927:Escherichia coli Infections / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D012307:Risk Factors; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases