Community Origins and Regional Differences Highlight Risk of Plasmid-mediated Fluoroquinolone Resistant Enterobacteriaceae Infections in Children.
Adolescent
Anti-Bacterial Agents
/ pharmacology
Case-Control Studies
Chicago
/ epidemiology
Child
Child, Preschool
Community-Acquired Infections
/ epidemiology
DNA, Bacterial
/ genetics
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae
/ drug effects
Enterobacteriaceae Infections
/ drug therapy
Fluoroquinolones
/ pharmacology
Humans
Infant
Infant, Newborn
Microbial Sensitivity Tests
Plasmids
/ genetics
Risk Factors
Tertiary Care Centers
Young Adult
Journal
The Pediatric infectious disease journal
ISSN: 1532-0987
Titre abrégé: Pediatr Infect Dis J
Pays: United States
ID NLM: 8701858
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
pubmed:
4
10
2018
medline:
1
5
2020
entrez:
4
10
2018
Statut:
ppublish
Résumé
Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children. A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection. Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found. The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
Sections du résumé
BACKGROUND
Fluoroquinolones are uncommonly prescribed in children, yet pediatric multidrug resistant (MDR) enterobacteriaceae (Ent) infections often reveal fluoroquinolone resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children.
METHODS
A case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation cephalosporin-resistant and/or carbapenem-resistant Ent infections. Polymerase chain reaction and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with third-generation cephalosporin, fluoroquinolone, and carbapenem-susceptible Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection.
RESULTS
Of 169 third-generation cephalosporin-resistant and/or carbapenem-resistant Ent isolates from children (median age, 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was Escherichia coli, and most common bla gene blaCTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac6'1bcr, oqxA/B, qepA and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (odds ratio, 33.1) of non-black-white-Hispanic race (odds ratio, 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use or healthcare differences were not found.
CONCLUSIONS
The strong association of infection with MDR organisms showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.
Identifiants
pubmed: 30281548
doi: 10.1097/INF.0000000000002205
pmc: PMC6440871
mid: NIHMS1507967
doi:
Substances chimiques
Anti-Bacterial Agents
0
DNA, Bacterial
0
Fluoroquinolones
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
595-599Subventions
Organisme : NIAID NIH HHS
ID : R01 AI100560
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI072219
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI063517
Pays : United States
Organisme : NIAID NIH HHS
ID : K08 AI112506
Pays : United States
Organisme : BLRD VA
ID : I01 BX001974
Pays : United States
Références
Antimicrob Agents Chemother. 2011 Sep;55(9):4457-60
pubmed: 21746960
J Pediatric Infect Dis Soc. 2014 Dec;3(4):320-8
pubmed: 26625452
Clin Infect Dis. 2010 Apr 1;50(7):979-87
pubmed: 20192731
Annu Rev Public Health. 2008;29:151-69
pubmed: 18348709
Front Microbiol. 2012 Apr 02;3:110
pubmed: 22485109
J Antimicrob Chemother. 2009 Mar;63(3):427-37
pubmed: 19155227
Infect Immun. 2002 Jun;70(6):3216-26
pubmed: 12011017
J Infect Dis. 2017 Feb 15;215(suppl_1):S28-S36
pubmed: 28375512
Circulation. 2003 Mar 18;107(10):1448-53
pubmed: 12642369
Clin Infect Dis. 2013 Nov;57(9):1246-52
pubmed: 23946222
Clin Infect Dis. 2015 May 1;60(9):1389-97
pubmed: 25595742
J Microbiol Methods. 2005 Dec;63(3):219-28
pubmed: 15935499
Curr Opin Microbiol. 2006 Oct;9(5):466-75
pubmed: 16942899
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):234-240
pubmed: 28992133
Antimicrob Agents Chemother. 2014 Jul;58(7):3997-4004
pubmed: 24798269
Emerg Infect Dis. 2015 Nov;21(11):2014-21
pubmed: 26486124
J Infect. 2008 Dec;57(6):441-8
pubmed: 18990451
J Clin Microbiol. 2009 May;47(5):1436-42
pubmed: 19297590
Pediatrics. 2017 Oct;140(4):
pubmed: 28872046
Travel Med Infect Dis. 2016 Nov - Dec;14(6):568-571
pubmed: 27890813
Infect Dis Clin North Am. 2018 Mar;32(1):1-17
pubmed: 29406971
J Pediatric Infect Dis Soc. 2014 Dec;3(4):312-9
pubmed: 26625451
Lancet Infect Dis. 2006 Oct;6(10):629-40
pubmed: 17008172
Front Public Health. 2013 Dec 19;1:69
pubmed: 24392444
Microb Drug Resist. 2005 Winter;11(4):378-82
pubmed: 16359198
Antimicrob Agents Chemother. 2016 May 23;60(6):3462-9
pubmed: 27021322