A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa

Abstract

IntroductionThere are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings.MethodsIn this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease.ResultsThere were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus.ConclusionsThese findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.

Colonisation with extended spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in children admitted to a paediatric referral hospital in South Africa

“…However, the risk factor analysis showed that hospitalisation for more than 7 days before enrolment was an independent risk factor for ESBL-PE colonisation. This finding strongly suggests that the healthcare environment is an important site of colonisation and is consistent with previous BSI studies that showed that 95% and 55% of K. pneumoniae and E. coli BSIs respectively are hospital-acquired or healthcare-associated [41,42].…”

“…invasive infection [44,51]. Furthermore, of K. pneumoniae and E. coli isolates causing BSI at RCWMCH, 83% and 30% are ESBL-PE, respectively [41,42]. This study was not designed to determine the timing of colonisation of ESBL-PE and CRE and hence we were unable to establish the extent of community versus hospital acquisition.…”

“…Despite the global distribution of these organisms and the association of their emergence due to widespread and indiscriminate use of broad-spectrum antibiotics, little is known about the epidemiology of ESBL-PE and CRE colonisation and infection on the African continent, especially in children. There have been reports of ESBL-PE infections in South Africa from the early 1990s, and some more recent studies describing ESBL-PE infections, but few colonisation studies [40][41][42][43]. One of the first reports of CRE infection and colonisation in children in South Africa described the treatment and outcome of a case series of invasive CRE infections [44].…”

Bacterial Distribution and Susceptibility in Bloodstream Infection in Primary-Care Hospital in Nova Friburgo, Rio de Janeiro

“…. The presence of this enzyme is a universal problem and occurs mainly due to the indiscriminate use of broad-spectrum cephalosporins in the hospital environment [Malande et al, 2019;Brixner et al, 2019].…”

Whole Genome Sequencing Differentiates Presumptive Extended Spectrum Beta-Lactamase Producing Escherichia coli along Segments of the One Health Continuum

“…ESBL-producing bacteria, including E. coli are frequently resistant to multiple antimicrobials including 3rd and 4th generation cephalosporins in addition to quinolones and aminoglycosides [1,2,4]. These bacteria have been designated priority group 1 pathogens for the development of alternative antimicrobial therapies by the World Health Organization [5] as they can cause serious urinary tract [6,7] and bloodstream [8][9][10] infections, occasionally resulting in mortalities [11].…”