Format

Send to

Choose Destination
Pediatr Infect Dis J. 2019 Jun;38(6):595-599. doi: 10.1097/INF.0000000000002205.

Community Origins and Regional Differences Highlight Risk of Plasmid-mediated Fluoroquinolone Resistant Enterobacteriaceae Infections in Children.

Author information

1
From the Pediatrics, Rush University Medical Center, Chicago, Illinois.
2
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
3
University of Illinois at Chicago.
4
Cook County Health and Hospital Systems.
5
Medicine, Rush University Medical Center, Chicago, Illinois.
6
Department of Pharmacology, Molecular Biology, Microbiology and Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.
7
Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago.
8
Pathology, Northwestern Feinberg School of Medicine, Chicago, Illinois.
9
Pediatrics, Loyola University Medical Center, Maywood, Illinois.
10
Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve School of Medicine, Cleveland, Ohio.

Abstract

BACKGROUND:

Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children.

METHODS:

A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection.

RESULTS:

Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found.

CONCLUSIONS:

The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.

PMID:
30281548
PMCID:
PMC6440871
[Available on 2020-06-01]
DOI:
10.1097/INF.0000000000002205

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center