title: Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection.
abstract: The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistantEnterobacteriaceaeWe also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistantEscherichia coliandKlebsiellaspp. isolated from normally sterile sites of patients aged <22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, andfumC-fimH(E. coli) ortonB(Klebsiella pneumoniae) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients withE. colisequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Sibani
authors.initials: S
authors.lastname: Das
authors.affiliation: Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Adler
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA.|Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Arianna
authors.initials: A
authors.lastname: Miles-Jay
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA.|Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kronman
authors.affiliation: Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.|Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Xuan
authors.initials: X
authors.lastname: Qin
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA.|Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Weissman
authors.affiliation: Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.|St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: C A
authors.identifier: 0000-0002-1137-840X
authors.initials: CA
authors.lastname: Burnham
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.|St. Louis Children's Hospital, St. Louis, Missouri, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Elward
authors.affiliation: Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA.|Children's Mercy, Kansas City, Missouri, USA.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Missouri, Kansas City, Missouri, USA.|Children's Mercy, Kansas City, Missouri, USA.
authors.forename: Rangaraj
authors.initials: R
authors.lastname: Selvarangan
authors.affiliation: Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Kaede V
authors.initials: KV
authors.lastname: Sullivan
authors.affiliation: Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.|The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA danielle.zerr@seattlechildrens.org.|Seattle Children's Research Institute, Seattle, Washington, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
mesh_terms: D018830:Adhesins, Escherichia coli / Q000235:genetics; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D001426:Bacterial Proteins / Q000235:genetics; D018550:Cephalosporin Resistance / Q000235:genetics; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D036781:Fimbriae Proteins / Q000235:genetics; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D018830:Adhesins, Escherichia coli; D000900:Anti-Bacterial Agents; D001425:Bacterial Outer Membrane Proteins; D001426:Bacterial Proteins; D002511:Cephalosporins; C058769:fimH protein, E coli; D036781:Fimbriae Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases
keywords: antibiotic resistance; pediatric infectious disease