Epidemiology and Burden of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal

Abstract

ContextSevere bacterial infections are not considered as a leading cause of death in young children in sub-Saharan Africa. The worldwide emergence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) could change the paradigm, especially in neonates who are at high risk of developing healthcare-associated infections.ObjectiveTo evaluate the epidemiology and the burden of ESBL-E bloodstream infections (BSI).MethodsA case-case-control study was conducted in patients admitted in a pediatric hospital during two consecutive years. Cases were patients with Enterobacteriaceae BSI and included ESBL-positive (cases 1) and ESBL-negative BSI (cases 2). Controls were patients with no BSI. Multivariate analysis using a stepwise logistic regression was performed to identify risk factors for ESBL acquisition and for fatal outcomes. A multistate model was used to estimate the excess length of hospital stay (LOS) attributable to ESBL production while accounting for time of infection. Cox proportional hazards models were performed to assess the independent effect of ESBL-positive and negative BSI on LOS.ResultsThe incidence rate of ESBL-E BSI was of 1.52 cases/1000 patient-days (95% CI: 1.2–5.6 cases per 1000 patient-days). Multivariate analysis showed that independent risk factors for ESBL-BSI acquisition were related to underlying comorbidities (sickle cell disease OR = 3.1 (95%CI: 2.3–4.9), malnutrition OR = 2.0 (95%CI: 1.7–2.6)) and invasive procedures (mechanical ventilation OR = 3.5 (95%CI: 2.7–5.3)). Neonates were also identified to be at risk for ESBL-E BSI. Inadequate initial antibiotic therapy was more frequent in ESBL-positive BSI than ESBL-negative BSI (94.2% versus 5.7%, p<0.0001). ESBL-positive BSI was associated with higher case-fatality rate than ESBL-negative BSI (54.8% versus 15.4%, p<0.001). Multistate modelling indicated an excess LOS attributable to ESBL production of 4.3 days. The adjusted end-of-LOS hazard ratio for ESBL-positive BSI was 0.07 (95%CI, 0.04–0.12).ConclusionControl of ESBL-E spread is an emergency in pediatric populations and could be achieved with simple cost-effective measures such as hand hygiene, proper management of excreta and better stewardship of antibiotic use, especially for empirical therapy.

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

“…ESBL-E occur worldwide in both community and hospital settings (Paterson and Bonomo, 2005;Pitout et al, 2005;Sonda et al, 2016;Storberg, 2014;Luvsansharav et al, 2011), and the reported incidence of infections in paediatric and neonatal populations is increasing (Paterson and Bonomo, 2005;Sonda et al, 2016;Storberg, 2014;Flokas et al, 2017;Peirano and Pitout, 2010;Tansarli et al, 2014;Dramowski et al, 2015;Logan et al, 2014). Clinical infections with ESBL-E are associated with increased morbidity (including prolonged hospital stay), increased healthcare costs, and higher mortality rates compared to infections with non- ESBL-E (Blomberg et al, 2005;Zaoutis et al, 2005;Kim et al, 2002;Ndir et al, 2016). Among neonates, children, and pregnant/ post-partum women, ESBL-E are frequently implicated in urinary tract infections (UTI) (Pitout et al, 2005;Peirano and Pitout, 2010) and bloodstream infections (BSI) (Luvsansharav et al, 2011;Flokas et al, 2017;Dramowski et al, 2015;Zaoutis et al, 2005;Loh and Sivalingam., 2007).…”

Prevalencia de &#946;-lactamasas de espectro extendido en enterobacterias causantes de sepsis neonatal y factores asociados

“…10 , no encontraron incremento en la probabilidad de morir en función de las BLEE. Ndir A. y cols., (Senegal) 3 , describieron que la mayoría de pacientes con infección por EP-BLEE reciben un esquema antimicrobiano empírico inadecuado (94,2 vs. 5,7%, p < 0,0001), lo que incrementa la tasa de mortalidad (OR 2,9, IC 95% 1,8-7,3).…”

“…as β-lactamasas de espectro extendido (BLEE), enzimas bacterianas que tienen la capacidad de inactivar penicilinas, monobactámicos y cefalosporinas, se trasmiten a través de plásmidos entre bacterias de la misma o de diferente especie. 1,2 En países en vías de desarrollo, donde la principal etiología de sepsis neonatal son enterobacterias, este mecanismo de resistencia cobra importancia por las implicaciones desfavorables sobre la morbilidad y/o mortalidad neonatal 3,4 .…”

Neonatal and paediatric bloodstream infections: Pathogens, antimicrobial resistance patterns and prescribing practice at Khayelitsha District Hospital, Cape Town, South Africa

“…[11] The widespread and uncontrolled use of cephalosporins has contributed to the increased prevalence of ESBL-producing organisms, which may lead to increased BSI mortality, longer hospital stays and increased healthcare costs. [12][13][14] The changing spectrum of pathogens, AMR patterns and clinical impact necessitates ongoing auditing, monitoring and publication of data on local pathogen profiles and antibiotic sensitivity patterns to inform clinical management and infection prevention efforts. [6,13,14] For neonates and children admitted to SA district hospitals, research on the epidemiology and AMR patterns of CA-and HA-BSI will inform development of appropriate empirical antibiotic recommendations.…”

“…[12][13][14] The changing spectrum of pathogens, AMR patterns and clinical impact necessitates ongoing auditing, monitoring and publication of data on local pathogen profiles and antibiotic sensitivity patterns to inform clinical management and infection prevention efforts. [6,13,14] For neonates and children admitted to SA district hospitals, research on the epidemiology and AMR patterns of CA-and HA-BSI will inform development of appropriate empirical antibiotic recommendations. Furthermore, there are very limited data on paediatric clinicians' prescribing practices to inform antimicrobial stewardship programmes at district hospitals.…”