International travel is a risk factor for extended-spectrum β-lactamase-producing  Enterobacteriaceae  acquisition in children: A case-case-control study in an urban U.S. hospital

Strysko, Jonathan; Mony, Vidya; Cleveland, Jeremiah; Siddiqui, Hanna; Homel, Peter; Gagliardo, Christina

doi:10.1016/j.tmaid.2016.11.012

Cited by 33 publications

(31 citation statements)

References 19 publications

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“…4,18 In the present cohort there was a significantly high resistance rate of ESBL producers to amoxicillin-clavulanate, aminoglycosides especially gentamycin, and quinolones, and negligible resistance to carbapenems. The resistance of the present ESBL cohort to quinolones was around 50%, similar to other studies, 5,8,9,19,22 making them an inappropriate oral formulation in these children. Hanna-Wakim et al in Lebanon demonstrated an increase of resistance to quinolones over time.…”

Section: Discussionsupporting

confidence: 89%

“…found a higher risk for ESBL infection in children with recurrent UTI in comparison with the first episode . In recent studies from the USA and Europe, international travel to Asia including Turkey and Middle Eastern countries was identified as a risk factor for acquisition of ESBL‐UTI …”

Section: Discussionmentioning

confidence: 99%

“…21 In recent studies from the USA and Europe, international travel to Asia including Turkey and Middle Eastern countries was identified as a risk factor for acquisition of ESBL-UTI. 22,23 There are new reports of ESBL-UTI, however, without clearly identifiable risk factors. 24 In a study from Korea, 60% of infants with ESBL-UTI had no identifiable risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Urinary tract infection caused by extended‐spectrum β‐lactamase‐producing bacteria: Risk factors and antibiotic resistance

Albaramki

Abdelghani

Dalaeen

et al. 2019

Pediatrics International

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Background The aim of this study was to investigate the risk factors for acquisition of extended spectrum β‐lactamase (ESBL)‐producing bacteria in community‐acquired urinary tract infection (UTI) and to evaluate their antimicrobial resistance. Methods The medical records of hospitalized children were retrospectively evaluated. Children with ESBL‐producing bacteria UTI were matched with controls with non‐ESBL‐producing bacteria UTI of the same age and gender. Results A total of 243 patients with community‐acquired UTI in a 5 year period were evaluated, of whom 46% had UTI caused by ESBL bacteria. Seventy‐seven cases were matched with 77 controls. There were no significant differences in the clinical presentation between the two groups apart from a longer hospital stay in the ESBL group (9.1 ± 5.5 days vs 8.0 ± 4.4 days, P = 0.013). Significant potential risk factors for ESBL‐UTI were previous use of antibiotics in the last 3 months, previous hospitalization in the last 3 months, history of recurrent UTI, and presence of renal anomalies. On logistic regression analysis, history of previous hospitalization in the last 3 months (OR, 3.83; 95%CI: 1.49–9.84) was identified as an independent significant risk factor for ESBL‐UTI. There was a significantly higher resistance to amoxicillin‐clavulanate, amikacin, gentamycin and quinolones in the ESBL group compared with the control group. Conclusion Recognizing the risk factors for ESBL‐UTI helps to identify the high‐risk cases and enables proper management.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Urinary tract infection caused by extended‐spectrum β‐lactamase‐producing bacteria: Risk factors and antibiotic resistance

Albaramki

Abdelghani

Dalaeen

et al. 2019

Pediatrics International

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“…Our sample size was relatively small, which may allow for selection bias; however, the pooling of multicentered data from institutions of differing types serving diverse populations throughout the 3rd largest metropolitan area in the U.S. potentially lessens this bias. The smaller sample sizes in pediatric studies are related to the overall low prevalence of these organisms in children in most U.S. areas (1-3%), including in the Chicago and the Midwest region (21,23,26), although national trends indicate an increase in prevalence of these menacing organisms in pediatric populations during the last decade, suggesting they are an emerging threat that needs further evaluation (7).…”

Section: Discussionmentioning

confidence: 99%

Community origins and regional differences highlight risk of plasmid-mediated fluoroquinolone resistant Enterobacteriaceae infections in children

Logan

Medernach

Rispens

et al. 2018

Preprint

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25Fluoroquinolones (FQs) are uncommonly prescribed in children, yet pediatric multidrug-resistant 26 (MDR)-Enterobacteriaceae (Ent) infections often reveal FQ resistance (FQR). We sought to 27 define the molecular epidemiology of FQR and MDR-Ent in children. A case-control analysis of 28 children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children 29 with third-generation-cephalosporin-resistant (3GCR) and/or carbapenem-resistant (CR)-Ent 30 infections. PCR and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. 31Controls were children with 3GC and carbapenem susceptible-Ent infections matched by age, 32 source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. 33Of 169 3GCR and/or CR Ent isolates from children (median age 4.8 years), 85 were FQR; 56 34 (66%) contained PMFQR genes. The predominant organism was E. coli and most common bla 35 gene bla CTX-M-1 group . In FQR isolates, PMFQR gene mutations included aac6'1b-36 cr, oqxA/B, qepA, and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. 37 coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, 38PMFQR Ent infections occurred mostly in outpatients (OR 33.1) of non-black-white-Hispanic 39 race (OR 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR-40 Ent infections than those in the reference region, while residence in Central Chicago was 41 associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, 42 antibiotic use, or healthcare differences were not found. The strong association of infection with 43 MDROs showing FQR with patient residence rather than with traditional risk factors suggests 44 that the community environment is a major contributor to spread of these pathogens in children. 45 46 47 48 Multi-drug resistant (MDR) Enterobacteriaceae infections are associated with significant 49 morbidity and mortality and are an emerging problem in children in the US during the last 50 decade (1, 2). Globally, this has been attributed mainly to the rise in extended-spectrum beta 51 lactamase (ESBL) producing Enterobacteriaceae (ESBL Ent) and carbapenem-resistant 52 Enterobacteriaceae (CRE) (3, 4). Increasing resistance to several other classes of antibiotics was 53 found in these studies; including to the fluoroquinolones, a class of antibiotics with limited 54 indications for use in children (1, 2). 55 The CTX-M-ESBL harboring Escherichia coli are among the most common multi-drug 56 resistant organisms (MDROs), often possessing resistance genes to other important antibiotic 57 classes including aminoglycosides, fluoroquinolones, tetracyclines, and trimethoprim-58 sulfamethoxazole (5, 6). In adults, fluoroquinolone resistance in (FQR) Gram-negative bacteria 59has been linked to chromosomal and to plasmid-mediated resistance mechanisms and is thought 60 to be associated mostly with the dramatic increase in use of these antibiotics during the 1980s(7, 61 8). 62The reasons f...

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“…Para el viajero, el riesgo es desarrollar una enfermedad por un género multirresistente, en especial una infección urinaria. En un estudio pediátrico de casos y controles en Estados Unidos, la probabilidad de sufrir una infección por una enterobacteria productora de ßlactamasa de espectro ampliado era nueve veces más elevada en caso de viaje internacional [28] . Otro riesgo es el de una transmisión del germen al entorno.…”

Section: Anamnesisunclassified

Conducta práctica ante un niño febril al regresar de un viaje

Minodier

Imbert

2019

EMC - Pediatría

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Las enfermedades más frecuentes al regresar de un viaje al extranjero son las infecciones gastrointestinales, las enfermedades febriles y los problemas dermatológicos. La evaluación de un niño febril al regreso de un viaje es clínica: verificación de los antecedentes y las vacunaciones, búsqueda de otros casos en contacto, signos funcionales y físicos, y características del viaje. Unas pruebas complementarias de rutina completan a menudo la evaluación para una orientación sindrómica. Si bien las causas de fiebre son, sobre todo, cosmopolitas, la gravedad de la enfermedad exótica obliga a buscarlas prioritariamente. El paludismo debe sospecharse ante una fiebre procedente de África subsahariana. El diagnóstico se basa en la asociación de un frotis sanguíneo y una prueba sensible (gota gruesa, reacción en cadena de la polimerasa [PCR]) o una prueba de diagnóstico rápido (para Plasmodium falciparum). Los criterios clínico-biológicos de gravedad son esenciales para orientar y tratar al paciente. En caso de acceso no complicado por P. falciparum, el tratamiento se basa en un tratamiento combinado a base de artemisinina (ACT), arteméter-lumefantrina o artenimol-piperaquina. Los accesos graves se tratan con artesunato intravenoso, seguido de ACT oral. Dengue, chikungunya e infección por virus Zika tienen características clínicas comunes (fiebre-erupción-artralgias, tratamiento sintomático). En caso de dengue, conviene controlar la aparición de signos de alerta, que podrían hacer temer una evolución negativa. El chikungunya es grave en caso de transmisión en el parto, con un riesgo de encefalitis neonatal. En el niño, el Zika es asintomático o poco sintomático. Pero, en caso de infección durante el embarazo, el riesgo es el de una embriofetopatía. El diagnóstico de estas arbovirosis se basa en la PCR en la fase aguda y en la serología secundariamente. La sintomatología de la fiebre tifoidea es poco específica, lo cual justifica la práctica de hemocultivos sistemáticos ante una fiebre tras un viaje. Su tratamiento se basa en las cefalosporinas de tercera generación o el ciprofloxacino, pero las resistencias aumentan. En suma, la diversidad de las etiologías de una fiebre al regreso de un viaje y la potencial gravedad de las infecciones importadas imponen una reflexión sobre el proceso de tratamiento de estos pacientes, en especial en lo referente al riesgo de fiebre hemorrágica. © 2019 Elsevier Masson SAS. Todos los derechos reservados.Conducta práctica ante un niño febril al regresar de un viaje 2 EMC -Pediatría Conducta práctica ante un niño febril al regresar de un viaje E -4-320-A-20

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International travel is a risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae acquisition in children: A case-case-control study in an urban U.S. hospital

Cited by 33 publications

References 19 publications

Urinary tract infection caused by extended‐spectrum β‐lactamase‐producing bacteria: Risk factors and antibiotic resistance

Urinary tract infection caused by extended‐spectrum β‐lactamase‐producing bacteria: Risk factors and antibiotic resistance

Community origins and regional differences highlight risk of plasmid-mediated fluoroquinolone resistant Enterobacteriaceae infections in children

Conducta práctica ante un niño febril al regresar de un viaje

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