Pediatric Infection and Intestinal Carriage due to Extended Spectrum Cephalosporin-Resistant Enterobacteriaceae.

Antimicrobial Agents and Chemotherapy (Impact Factor: 4.57). 05/2014; DOI: 10.1128/AAC.02558-14
Source: PubMed

ABSTRACT The objective of this study is to describe the epidemiology of intestinal carriage with extended spectrum cephalosporin-resistant Enterobacteriaceae in children with index infections with these organisms. Patients with resistant E. coli or Klebsiella isolated from the urine or a normally sterile site between January 2006 and December 2010 were included in this study. Available infection and stool isolates underwent phenotypic and molecular characterization. Clinical data relevant to the infections were collected and analyzed. Overall, 105 patients were identified with 106 extended spectrum cephalosporin resistant E. coli (n=92) or Klebsiella species (n=14) isolated from urine or a sterile site. Among the 27 patients who also had stool screening for resistant Enterobacteriaceae, 17 (63%) had intestinal carriage lasting a median of 199 days (range, 62-1576). There were no significant differences in demographic, clinical, and microbiological variables between those with versus those without intestinal carriage. Eighteen (17%) patients had 37 subsequent resistant Enterobacteriaceae infections identified: 31 urine and 6 blood. In a multivariable analysis, antibiotic intake in the 91 days prior to subsequent urine culture was significantly associated with subsequent urinary tract infection with a resistant organism (hazard ratio 14.3, 95% CI 1.6 - 130.6). Intestinal carriage and reinfection were most commonly due to bacterial strains of the same sequence type and with the same resistant determinants as the index extended spectrum cephalosporin-resistant Enterobacteriaceae, but carriage and reinfection with different resistant Enterobacteriaceae strains also occurred.

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