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Bulut ME, Hürkal G, Dalgıç N. Investigation of High-Risk ST131 Clone in Extended Spectrum β-Lactamase–Producing Escherichia coli Isolates in Children. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1730995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Objective Antimicrobial resistance poses a serious threat to children's health. In recent years, high-risk Escherichia coli ST131 has become an important target for global surveillance studies. The E.coli ST131 clone is associated with extended spectrum β-lactamase (ESBL) production, as well as multidrug resistance and treatment failure. Studies on this clone in the pediatric age group are limited. We aim to investigate the rate of high-risk E. coli ST131 clone in ESBL-positive E. coli isolates obtained from pediatric patients.
Methods A total of 292 ESBL-positive E. coli isolates from clinical samples of pediatric patients was included in the study. MALDI-TOF MS system was used for bacterial identification. Susceptibility tests were performed using BD Phoenix automated system. ST131 detection was done by MALDI-TOF-MS. Fisher's exact test was used to compare the groups (significance <0.05).
Results A total of 292 isolates was analyzed. The high-risk ST131 clone was detected in 117 (40%) of the 292 ESBL-positive isolates. ST131 rates were found to be significantly higher in children under the age of 5 years compared with children over the age of 5 years (49.3 vs. 31.1%, p = 0.0019). Ciprofloxacin resistance was higher in ST131 isolates (45.6 vs. 31.7%; p < 0.05).
Conclusion The rate of the ST131 clone was found to be high in the pediatric population. The significantly high rate of resistance to ciprofloxacin, which is not commonly used in the pediatric population, in ST131 isolates reveals the importance of the spread of high-risk clones for the development of resistance.
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Affiliation(s)
- Mehmet E. Bulut
- Department of Medical Microbiology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gülen Hürkal
- Department of Medical Microbiology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nazan Dalgıç
- Division of Pediatric Infectious Diseases, Health Sciences University, Sariyer Etfal Training and Research Hospital, Istanbul, Turkey
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Logan LK, Rispens JR, Medernach RL, Domitrovic TN, Hujer AM, Marshall SH, Rudin SD, Qureshi NK, Zheng X, Hayden MK, Weinstein RA, Bonomo RA. A Multicentered Study of the Clinical and Molecular Epidemiology of TEM- and SHV-type Extended-Spectrum Beta-Lactamase Producing Enterobacterales Infections in Children. Pediatr Infect Dis J 2021; 40:39-43. [PMID: 33021591 PMCID: PMC7721995 DOI: 10.1097/inf.0000000000002916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales-(Ent) infections are increasing in pediatrics. Before CTX-M ESBL emerged, the most common infection-associated ESBL genes were TEM and SHV-type ESBLs. We sought to define the current epidemiology of Ent infections in children due to blaTEM and blaSHV (TEM-SHV-Ent). METHODS A retrospective case-control analysis of children with TEM-SHV-Ent infections at 3 Chicago-area hospitals was performed. Cases had extended-spectrum-cephalosporin (ESC)-resistant infections due to blaTEM or blaSHV. DNA analysis assessed β-lactamase (bla) genes, multilocus sequence types, and E. coli phylogenetic grouping. Controls had ESC-susceptible Ent infections, matched 3:1 to cases by age, source, and hospital. Clinical-epidemiologic infection predictors were assessed. RESULTS Of 356 ESC-R-Ent isolates from children (median 4.3 years), 38 (10.7%) were positive solely for blaTEM-ESBL (26%) or blaSHV-ESBL genes (74%). Predominant organisms were Klebsiella (34.2%) and E. coli (31.6%); 67% of E. coli were phylogroup B2. Multilocus sequence types revealed multiple strains, 58% resistant to ≥3 antibiotic classes. On multivariable analysis, children with TEM-SHV-Ent infections more often had recent inpatient care (OR, 8.2), yet were diagnosed mostly as outpatients (OR, 25.6) and less in Neonatal Intensive Care Units (OR, 0.036) than controls. TEM-SHV-Ent patients had more gastrointestinal (OR, 23.7) and renal comorbidities (OR, 4.2). Differences in demographics, antibiotic exposure, and foreign bodies were not found. CONCLUSION TEM-SHV-Ent are commonly linked to inpatient exposures in children with chronic conditions but most often present in outpatient settings. Clinicians should be aware of the potential increased risk for TEM-SHV-Ent infections in outpatients with gastrointestinal and renal comorbidities and histories of prolonged hospital stays.
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Affiliation(s)
- Latania K. Logan
- Pediatrics, Rush University Medical Center, Chicago, Illinois, United States
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Jared R. Rispens
- Pediatrics, Rush University Medical Center, Chicago, Illinois, United States
- Medicine, Rush University Medical Center, Chicago, Illinois, United States
| | - Rachel L. Medernach
- Pediatrics, Rush University Medical Center, Chicago, Illinois, United States
- Medicine, Rush University Medical Center, Chicago, Illinois, United States
| | - T. Nicholas Domitrovic
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Andrea M. Hujer
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Steven H. Marshall
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Susan D. Rudin
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Nadia K. Qureshi
- Pediatrics, Loyola University Medical Center, Maywood, Illinois, United States
| | - Xiaotian Zheng
- Microbiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
- Pathology, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States
| | - Mary K. Hayden
- Medicine, Rush University Medical Center, Chicago, Illinois, United States
| | - Robert A. Weinstein
- Medicine, Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health and Hospital Systems, Chicago, Illinois, United States
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
- Pharmacology, Molecular Biology, and Microbiology, Case Western Reserve School of Medicine, Cleveland, Ohio
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Miles-Jay A, Weissman SJ, Adler AL, Baseman JG, Zerr DM. Whole Genome Sequencing Detects Minimal Clustering Among Escherichia coli Sequence Type 131-H30 Isolates Collected From United States Children's Hospitals. J Pediatric Infect Dis Soc 2020; 10:183-187. [PMID: 32185378 PMCID: PMC7996643 DOI: 10.1093/jpids/piaa023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/28/2020] [Indexed: 11/13/2022]
Abstract
We applied whole genome sequencing to identify putative transmission clusters among clinical multidrug-resistant Escherichia coli sequence type 131-H30 isolates from 4 United States children's hospitals. Of 126 isolates, 17 were involved in 8 putative transmission clusters; 4 clusters showed evidence of healthcare-associated epidemiologic linkages. Geographic clustering analyses showed weak geographic clustering.
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Affiliation(s)
- Arianna Miles-Jay
- Department of Epidemiology, University of Washington, Seattle, Washington, USA,Seattle Children’s Research Institute, Seattle, Washington, USA,Corresponding Author: Arianna Miles-Jay, PhD, MPH, University of Michigan Medical School, 1150 W Medical Center Dr, Medical Science Research Bldg I, Rm 1511, Ann Arbor, MI 48109. E-mail: . Present affiliation: Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott J Weissman
- Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Amanda L Adler
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Janet G Baseman
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Danielle M Zerr
- Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Logan LK, Medernach RL, Domitrovic TN, Rispens JR, Hujer AM, Qureshi NK, Marshall SH, Nguyen DC, Rudin SD, Zheng X, Konda S, Weinstein RA, Bonomo RA. The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children. Infect Dis Ther 2019; 8:243-254. [PMID: 30772921 PMCID: PMC6522575 DOI: 10.1007/s40121-019-0237-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction The pandemic of extended-spectrum beta-lactamase-(ESBL)-producing Enterobacteriaceae (Ent) is strongly linked to the dissemination of CTX-M-type-ESBL-Ent. We sought to define the epidemiology of infections in children due to an emerging resistance type, CTX-M-9-group-producing-Ent (CTX-M-9-grp-Ent). Methods A retrospective matched case-control analysis of children with CTX-M-9-grp-Ent infections who received medical care at three Chicago area hospitals was performed. Cases were defined as children possessing extended-spectrum cephalosporin-resistant (ESC-R) infections due to blaCTX-M-9. PCR and DNA analysis assessed beta-lactamase (bla) genes, multi-locus sequence types (MLST) and phylogenetic grouping of E. coli. Controls were children with ESC-susceptible (ESC-S)-Ent infections matched one case to three controls by age, source, and hospital. The clinical-epidemiologic predictors of CTX-M-9-grp-Ent infection were assessed. Results Of 356 ESC-R-Ent isolates from children (median age 4.1 years), the CTX-M-9-group was the solely detected bla gene in 44 (12.4%). The predominant species was E. coli (91%) of virulent phylogroups D (60%) and B2 (40%). MLST revealed multiple strain types. On multivariable analysis, CTX-M-9-grp-Ent occurred more often in E. coli than other Ent genera (OR 7.4, 95% CI 2.4, 27.2), children of non-Black-White-Hispanic race (OR 7.4, 95% CI 2.4, 28.2), and outpatients (OR 4.5, 95% CI 1.7, 12.3), which was a very unexpected finding for infections due to antibiotic-resistant bacteria. Residents of South Chicago had a 6.7 times higher odds of having CTX-M-9-grp-Ent infections than those in the reference region (West), while residence in Northwestern Chicago was associated with an 81% decreased odds of infection. Other demographic, comorbidity, invasive-device, and antibiotic use differences were not found. Conclusion CTX-M-9-grp-Ent infection may be associated with patient residence and is occurring in children without traditional in-patient exposure risk factors. This suggests that among children, the community environment may be a key contributor in the spread of these resistant pathogens.
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Affiliation(s)
- Latania K Logan
- Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL, USA. .,Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA. .,Cook County Health and Hospital Systems, Chicago, IL, USA.
| | - Rachel L Medernach
- Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL, USA.,Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL, USA
| | - T Nicholas Domitrovic
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Jared R Rispens
- Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL, USA.,Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL, USA
| | - Andrea M Hujer
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Nadia K Qureshi
- Pediatrics, Loyola University Medical Center, Maywood, IL, USA
| | - Steven H Marshall
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - David C Nguyen
- Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, IL, USA.,Case Western Reserve School of Medicine, Cleveland, OH, USA.,Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL, USA
| | - Susan D Rudin
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Xiaotian Zheng
- Microbiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sreenivas Konda
- Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert A Weinstein
- Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL, USA.,Cook County Health and Hospital Systems, Chicago, IL, USA
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve School of Medicine, Cleveland, OH, USA.,Pharmacology, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.,Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.,Biochemistry, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA.,Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
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