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Community-Onset Extended-Spectrum ß-Lactamase–Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France

Section Editor(s): Dessein., RodrigueToubiana, Julie MD; Timsit, Sandra MD; Ferroni, Agnès MD; Grasseau, Marie MD; Nassif, Xavier MD; Lortholary, Olivier MD; Zahar, Jean-Ralph MD; Chalumeau, Martin MD

doi: 10.1097/MD.0000000000003163
Research Article: Observational Study

Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.

We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.

From the Department of General Pediatrics and Pediatric Infectious Disease (JT, MG, MC); Department of Pediatric Emergency (ST); Department of Microbiology (AF, XN, J-RZ); Department of Infectious Diseases and Tropical Medicine (OL), Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université Paris Descartes, IHU Imagine, Paris; and Unité de Prévention et de Lutte contre les Infections Nosocomiales (J-RZ), CHU d’Angers, Université d’Angers, Angers, France.

Correspondence: Julie Toubiana, Department of General Pediatrics and Pediatric Infectious Diseases, Necker Enfants-Malades Hospital, Paris, France (e-mail: julie.toubiana@nck.aphp.fr).

Abbreviations: ESBL-PE = extended spectrum β-lactamases-producing Enterobacteriaceae , MIC = minimal inhibitory concentration, UTI = urinary tract infection.

The authors have no funding and conflicts of interest to disclose.

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This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

Received December 22, 2015

Received in revised form February 22, 2016

Accepted February 23, 2016

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