The Molecular and Clinical Epidemiology of Extended-Spectrum Cephalosporin- and Carbapenem-Resistant Enterobacteriaceae at 4 US Pediatric Hospitals.
OBJECTIVE
In this report, we aim to describe the epidemiology of extended-spectrum cephalosporin-resistant (ESC-R) and carbapenem-resistant (CR) Enterobacteriaceae infections in children.


METHODS
ESC-R and CR Enterobacteriaceae isolates from normally sterile sites of patients aged <22 years from 4 freestanding pediatric medical centers were collected along with the associated clinical data.


RESULTS
The overall frequencies of ESC-R and CR isolates according to hospital over the 4-year study period ranged from 0.7% to 2.8%. Rates of ESC-R or CR Escherichia coli and Klebsiella pneumoniae varied according to hospital and ranged from 0.75 to 3.41 resistant isolates per 100 isolates (P < .001 for any differences). E coli accounted for 272 (77%) of the resistant isolates; however, a higher rate of resistance was observed in K pneumoniae isolates (1.78 vs 1.27 resistant isolates per 100 same-species isolates, respectively; P = .005). One-third of the infections caused by ESC-R or CR E coli were community-associated. In contrast, infections caused by ESC-R or CR K pneumoniae were more likely than those caused by resistant E coli to be healthcare- or hospital-associated and to occur in patients with an indwelling device (P ≤ .003 for any differences, multivariable logistic regression). Nonsusceptibility to 3 common non-β-lactam agents (ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole) occurred in 23% of the ESC-R isolates. The sequence type 131-associated fumC/fimH-type 40-30 was the most prevalent sequence type among all resistant E coli isolates (30%), and the clonal group 258-associated allele tonB79 was the most prevalent allele among all resistant K pneumoniae isolates (10%).


CONCLUSIONS
The epidemiology of ESC-R and CR Enterobacteriaceae varied according to hospital and species (E coli vs K pneumoniae). Both community and hospital settings should be considered in future research addressing pediatric ESC-R Enterobacteriaceae infection.
Departments of Pediatrics University of Washington, Seattle.|Seattle Children's Research Institute, Washington.
Danielle M
DM
Zerr
Departments of Pediatrics University of Washington, Seattle.|Seattle Children's Research Institute, Washington.
Scott J
SJ
Weissman
Departments of Pediatrics University of Washington, Seattle.|Seattle Children's Research Institute, Washington.
Chuan
C
Zhou
Departments of Pediatrics University of Washington, Seattle.|Seattle Children's Research Institute, Washington.
Matthew P
MP
Kronman
Seattle Children's Research Institute, Washington.
Amanda L
AL
Adler
Seattle Children's Research Institute, Washington.
Jessica E
JE
Berry
Seattle Children's Research Institute, Washington.
Jaipreet
J
Rayar
Seattle Children's Research Institute, Washington.
Jeff
J
Myers
Seattle Children's Research Institute, Washington.
Wren L
WL
Haaland
Departments of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri.|Department of Pediatrics, St. Louis Children's Hospital, Missouri.
Carey-Ann D
CD
Burnham
Department of Pediatrics, St. Louis Children's Hospital, Missouri.|Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
Alexis
A
Elward
Department of Pediatrics, University of Missouri, Kansas City, Missouri.|Children's Mercy, Kansas City, Missouri.
Jason
J
Newland
Children's Mercy, Kansas City, Missouri.|Department of Pathology and Laboratory Medicine, University of Missouri, Kansas City, Missouri.
Rangaraj
R
Selvarangan
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.|Children's Hospital of Philadelphia, Pennsylvania.
Kaede V
KV
Sullivan
Children's Hospital of Philadelphia, Pennsylvania.|Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Theoklis
T
Zaoutis
Seattle Children's Research Institute, Washington.|Departments of Laboratory Medicine, University of Washington, Seattle.
Xuan
X
Qin
D000293:Adolescent; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000235:genetics; D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D017720:Molecular Epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
Enterobacteriaceae; pediatrics; resistance