Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Children: Old Foe, Emerging Threat

Abstract

Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae present an ever-growing burden in the hospital and community settings, across all ages and demographics. Infections due to ESBL-containing pathogens continue to be associated with significant morbidity and mortality worldwide. With widespread empiric broad-spectrum β-lactam use creating selective pressure, and the resultant emergence of stable, rapidly proliferating ESBL-producing clones with continued horizontal gene transfer across genera, addressing this issue remains imperative. Although well characterized in adults, the epidemiology, risk factors, outcomes, therapies, and control measures for ESBL-producing bacteria are less appreciated in children. This analysis provides a brief summary of ESBL-producing Enterobacteriaceae in children, with a focus on recent clinical and molecular data regarding colonization and infection in nonoutbreak settings.

Prevalence and resistance profile of extended-spectrum -lactamases-producing Enterobacteriaceae in Ouagadougou, Burkina Faso

“…This variation in findings could be explained by the size, duration and area where the two studies were conducted. The clinical impact of ESBLproducing pathogens on morbidity and mortality in infectious diseases in both children and adults as well as their economic burden are well documented (Lukac et al, 2015). Thus, ESBL-E is a threat that should be tackled head on.…”

“…The ESBLs first described in 1983 in Germany arose from a single nucleotide polymorphism in the bla SHV genes that altered specificity to oxyimino-cephalosporins. Overtime there has been a wide spread of ESBLs with an ever evolving ability to hydrolyze penicillins, first, second and third generation cephalosporins and monobactams but not carbapenems (Lukac et al, 2015;Tekiner and Ozpinar, 2016). In Africa, there has been various reports of ESBL producing Enterobacteriaceae (ESBL-E) implicated in causing infections across all ages.…”

Analysis of β-Lactamase Resistance Determinants in Enterobacteriaceae from Chicago Children: a Multicenter Survey

“…CTX-M-type ESBLs were the most common bla genes detected; they were found in 152 of 225 Enterobacteriaceae isolates (67.6%). Approximately half (49.8%) belonged to the bla CTX-M-1 group, which contains bla CTX-M-15 , the gene most frequently associated with pandemic CTX-M E. coli strains (1,23 b Isolates may contain more than one bla gene; 9.3% (n ϭ 21) of the isolates were bla gene negative. Wild-type, narrow-spectrum bla genes were not included in the totals.…”

Prevalence of qnr, intI, and intII genes in extendedspectrum beta-lactamase (ESBL)-producing <i>Escherichia coli</i> isolated from clinical samples in Iran

“…Extended-spectrum β-lactamase (ESBLs) such as E. coli and Klebsiella pneumonia are frequently prevalent in the Enterobacteriaceae family [1,2]. In recent years, ESBL-producing E. coli has mostly been implicated in nosocomial infections [3].…”