A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children

Abstract

Background: Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales-(Ent) infections are increasing in pediatrics. Before CTX-M ESBL emerged, the most common infection-associated ESBL genes were TEM and SHV-type ESBLs. We sought to define the current epidemiology of Ent infections in children due to bla TEM and bla SHV (TEM-SHV-Ent). Methods: A retrospective case-control analysis of children with TEM-SHV-Ent infections at 3 Chicago-area hospitals was performed. Cases had extended-spectrum-cephalosporin (ESC)-resistant infections due to bla TEM or bla SHV. DNA analysis assessed β-lactamase (bla) genes, multilocus sequence types, and E. coli phylogenetic grouping. Controls had ESC-susceptible Ent infections, matched 3:1 to cases by age, source, and hospital. Clinical-epidemiologic infection predictors were assessed. Results: Of 356 ESC-R-Ent isolates from children (median 4.3 years), 38 (10.7%) were positive solely for bla TEM-ESBL (26%) or bla SHV-ESBL genes (74%). Predominant organisms were Klebsiella (34.2%) and E. coli (31.6%); 67% of E. coli were phylogroup B2. Multilocus sequence types revealed multiple strains, 58% resistant to ≥3 antibiotic classes. On multivariable analysis, children with TEM-SHV-Ent infections more often had recent inpatient care (OR, 8.2), yet were diagnosed mostly as outpatients (OR, 25.6) and less in Neonatal Intensive Care Units (OR, 0.036) than controls. TEM-SHV-Ent patients had more gastrointestinal (OR, 23.7) and renal comorbidities (OR, 4.2). Differences in demographics, antibiotic exposure, and foreign bodies were not found. Conclusion: TEM-SHV-Ent are commonly linked to inpatient exposures in children with chronic conditions but most often present in outpatient settings. Clinicians should be aware of the potential increased risk for TEM-SHV-Ent infections in outpatients with gastrointestinal and renal comorbidities and histories of prolonged hospital stays.

The role of the plasmid-mediated fluoroquinolone resistance genes as resistance mechanisms in pediatric infections due to Enterobacterales

“…However, we found that among children, the mechanisms of both β-lactam and FQR are diverse, and there is significant horizontal gene transfer occurring among the Enterobacterales genera ( Logan et al., 2016 ; Logan et al., 2019a ; Logan et al., 2019b ; Logan et al., 2019c ; Logan et al., 2020a ). Over 25% of isolates phenotypically susceptible to fluoroquinolones harbored an FQR gene.…”

Long-term gut colonization with ESBL-producingEscherichia coliin participants without known risk factors from the southeastern United States

“…ESBL enzymes confer resistance to multiple antibiotics including penicillin, monobactams, and cephalosporins, commonly used to treat infections caused by Gram negative bacteria (9). There are multiple classes of ESBL enzymes including TEM, SHV, OXA and CTX-M (10)(11)(12). Recently, attention has been drawn to the CTX-M class ESBLs as it is currently the most common ESBL found worldwide (13)(14)(15)(16).…”