Prevalence of ESBL-Producing Enterobacteriaceae in Pediatric Bloodstream Infections: A Systematic Review and Meta-Analysis

Abstract

BackgroundPediatric bloodstream infections (BSIs) with Extended-Spectrum Beta-Lactamase- producing Enterobacteriaceae (ESBL-PE) are associated with worse clinical outcomes. We aimed to estimate the prevalence of and the mortality associated with ESBL-PE in this patient population.MethodsA systematic review and meta-analysis using PubMed and EMBASE and included studies reporting the prevalence of ESBL-PE among confirmed BSIs in patients <19 years old.ResultsTwenty three (out of 1,718 non-duplicate reports) studies that provided data on 3,381 pediatric BSIs from 1996 to 2013 were included. The prevalence of ESBL-PE was 9% [95%CI (6, 13)] with an annual increase of 3.2% (P = 0.04). The prevalence was 11% [95%CI (6, 17)] among neonates, compared to 5% [95%CI (0, 14)] among children older than 28 days. The pooled prevalence was 15% in Africa [95%CI (8, 23)], 12% in South America [95%CI (5, 23)], 11% in India [95%CI (7, 17)], 7% in the rest of Asia [95%CI (0, 22)], 4% in Europe [95%CI (1, 7)] and 0% in Oceania [95%CI (0, 3)]. Importantly, the mortality in neonates with BSI due to ESBL-PE was 36% [95%CI (22, 51)], compared to 18% [95%CI (15, 22)] among all other neonates with BSI and this difference was statistically significant (P = 0.01).ConclusionsIn the pediatric population, the prevalence of BSI due to ESBL-PE is significant and is associated with increased mortality in neonates. Further studies are warranted to establish a high-risk group and the evaluation of preventive measures, such as antibiotic stewardship programs and infection control measures, in this population is urgently needed.

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

“…ESBL-E occur worldwide in both community and hospital settings (Paterson and Bonomo, 2005;Pitout et al, 2005;Sonda et al, 2016;Storberg, 2014;Luvsansharav et al, 2011), and the reported incidence of infections in paediatric and neonatal populations is increasing (Paterson and Bonomo, 2005;Sonda et al, 2016;Storberg, 2014;Flokas et al, 2017;Peirano and Pitout, 2010;Tansarli et al, 2014;Dramowski et al, 2015;Logan et al, 2014). Clinical infections with ESBL-E are associated with increased morbidity (including prolonged hospital stay), increased healthcare costs, and higher mortality rates compared to infections with non- ESBL-E (Blomberg et al, 2005;Zaoutis et al, 2005;Kim et al, 2002;Ndir et al, 2016).…”

“…Clinical infections with ESBL-E are associated with increased morbidity (including prolonged hospital stay), increased healthcare costs, and higher mortality rates compared to infections with non- ESBL-E (Blomberg et al, 2005;Zaoutis et al, 2005;Kim et al, 2002;Ndir et al, 2016). Among neonates, children, and pregnant/ post-partum women, ESBL-E are frequently implicated in urinary tract infections (UTI) (Pitout et al, 2005;Peirano and Pitout, 2010) and bloodstream infections (BSI) (Luvsansharav et al, 2011;Flokas et al, 2017;Dramowski et al, 2015;Zaoutis et al, 2005;Loh and Sivalingam., 2007). Among neonatal ESBL-E infections, Klebsiella pneumoniae and Escherichia coli are the most frequently isolated species (Flokas et al, 2017;Dramowski et al, 2015;Zaidi et al, 2005).…”

“…Although ESBL-E are well-documented as important bloodstream pathogens in several African settings (Flokas et al, 2017;Kim et al, 2002;Kang et al, 2004;Schiappa et al, 1996), little is known about the determinants and magnitude of maternal colonization with ESBL-E. Factors contributing to the development of AMR (including ESBL-E) in Africa include socio-economic challenges and health-associated factors (Kariuki and Dougan, 2014) (suboptimal hygiene and sanitation (Toole et al, 1995), weak health systems (Essack et al, 2016), lack of laboratory capacity (Okeke et al, 1999), and misuse of and easy access to antibiotics (Okeke et al, 1999)). A high burden of immunocompromised patients (HIV infection (Emacar et al, 2010) and diabetes (Ntirenganya et al, 2015)), environmental contamination (Dusé, 2005), and inadequate decontamination of medical devices (Dusé, 2005), are other important factors exacerbating AMR pathogen transmission in Africa.…”

Documento de posicionamiento de la Asociación Española de Pediatría-Sociedad Española de Infectología Pediátrica sobre el tratamiento de las infecciones por bacterias multirresistentes

“…En los últimos años se ha evidenciado un incremento notable en la prevalencia de enterobacterales productores de BLEE, tanto a nivel hospitalario como comunitario. 12 Entre los factores de riesgo asociados (2) Cuando se indique tratamiento oral, no existe solución de clindamicina comercializada en algunos países, por lo que cotrimoxazol constituye una posible alternativa.…”

An Improved Extended-Spectrum-β-Lactamase Detection Test Utilizing Aztreonam plus Clavulanate

“…Recently, some laboratories abandoned ESBL testing for therapeutic purposes, in the belief that lowered breakpoints of certain cephalosporins and aztreonam eliminated the risk of therapeutic failures with these drugs (4,5). This has created controversy over whether ESBL testing is really warranted (6)(7)(8)(9)(10)(11)(12)(13)(14). Irrespective of the debate about the value of ESBL testing, laboratories that continue to test must cope with some unresolved issues.…”