Community-Onset Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France

Abstract

Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.

Extended‐spectrum β‐lactamase‐producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre

“…This highlights the specificity of our centre, which specialises in urological pathologies. Our results are consistent with a previous study, which reported a prevalence of 5.1% of all community-acquired infections due to ESBL-producing bacteria in the general paediatric ward of Necker-Enfants Malades Hospital during 2012 (15).…”

“…However, the prevalence in our hospital remained under the 10% threshold which is used in France to justify changing the first-line treatment for paediatric febrile UTIs (13,14). Our results are consistent with a previous study, which reported a prevalence of 5.1% of all community-acquired infections due to ESBL-producing bacteria in the general paediatric ward of Necker-Enfants Malades Hospital during 2012 (15). Our results may not reflect the overall prevalence of ESBL UTIs in France, because our study focused on the situation in a university paediatric emergency ward.…”

Prevalence and molecular typing of extended-spectrum -lactamases in Escherichia coli, Enterobacter cloacae and Citrobacter freundii isolates from Laghouat Hospital, Algeria

“…This rate of ESBLs isolates is in accordance with those reported in Kingdom of Saudi Arabia (8.9%) (El-Khizzi and Bakheshwain, 2006), but even higher than the rate observed in recent European studies, from 2.4% to 5.1% in France (Toubiana et al, 2016), and 2.9% in Sweden (Kaarme et al, 2013). Studies conducted in Ethiopia (Mulisa et al, 2016) reported the prevalence rate of 25% of ESBLs producers respectively among Enterobacteriaceae family.…”

High Prevalence of ESBL-Producing Klebsiella pneumoniae Causing Community-Onset Infections in China

“…In the tertiary hospitals of China, approximate 50% nosocomial-acquired infections are caused by ESBL-Kp and bla CTX-M-15 and bla CTX-M-14 are the predominant genotypes (Wang Q. et al, 2013; Li et al, 2014; Yang et al, 2015). Recently, the prevalence rate of ESBL-Kp in community-acquired infections is increasing even causing invasive infection (Kassakian and Mermel, 2014; Toubiana et al, 2016). However, limited knowledge about the dissemination of community-onset ESBL-Kp on national scale in China, especially in settings of secondary hospitals or primary health care.…”