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Infect Dis Ther. 2019 Feb 16. doi: 10.1007/s40121-019-0237-2. [Epub ahead of print]

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children.

Author information

1
Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL, USA. Latania_Logan@rush.edu.
2
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA. Latania_Logan@rush.edu.
3
Cook County Health and Hospital Systems, Chicago, IL, USA. Latania_Logan@rush.edu.
4
Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL, USA.
5
Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL, USA.
6
Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.
7
Case Western Reserve School of Medicine, Cleveland, OH, USA.
8
Pediatrics, Loyola University Medical Center, Maywood, IL, USA.
9
Microbiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
10
Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
11
Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.
12
Cook County Health and Hospital Systems, Chicago, IL, USA.
13
Pharmacology, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.
14
Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.
15
Biochemistry, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.
16
Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.

Abstract

INTRODUCTION:

The pandemic of extended-spectrum beta-lactamase-(ESBL)-producing Enterobacteriaceae (Ent) is strongly linked to the dissemination of CTX-M-type-ESBL-Ent. We sought to define the epidemiology of infections in children due to an emerging resistance type, CTX-M-9-group-producing-Ent (CTX-M-9-grp-Ent).

METHODS:

A retrospective matched case-control analysis of children with CTX-M-9-grp-Ent infections who received medical care at three Chicago area hospitals was performed. Cases were defined as children possessing extended-spectrum cephalosporin-resistant (ESC-R) infections due to blaCTX-M-9. PCR and DNA analysis assessed beta-lactamase (bla) genes, multi-locus sequence types (MLST) and phylogenetic grouping of E. coli. Controls were children with ESC-susceptible (ESC-S)-Ent infections matched one case to three controls by age, source, and hospital. The clinical-epidemiologic predictors of CTX-M-9-grp-Ent infection were assessed.

RESULTS:

Of 356 ESC-R-Ent isolates from children (median age 4.1 years), the CTX-M-9-group was the solely detected bla gene in 44 (12.4%). The predominant species was E. coli (91%) of virulent phylogroups D (60%) and B2 (40%). MLST revealed multiple strain types. On multivariable analysis, CTX-M-9-grp-Ent occurred more often in E. coli than other Ent genera (OR 7.4, 95% CI 2.4, 27.2), children of non-Black-White-Hispanic race (OR 7.4, 95% CI 2.4, 28.2), and outpatients (OR 4.5, 95% CI 1.7, 12.3), which was a very unexpected finding for infections due to antibiotic-resistant bacteria. Residents of South Chicago had a 6.7 times higher odds of having CTX-M-9-grp-Ent infections than those in the reference region (West), while residence in Northwestern Chicago was associated with an 81% decreased odds of infection. Other demographic, comorbidity, invasive-device, and antibiotic use differences were not found.

CONCLUSION:

CTX-M-9-grp-Ent infection may be associated with patient residence and is occurring in children without traditional in-patient exposure risk factors. This suggests that among children, the community environment may be a key contributor in the spread of these resistant pathogens.

KEYWORDS:

Children; Drug resistance; Enterobacteriaceae infections; Epidemiology; Gram-negative bacteria

PMID:
30772921
DOI:
10.1007/s40121-019-0237-2

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