Extended-spectrum β-lactamase-producing pathogens in a children's hospital: A 5-year experience

Blaschke, Anne J.; Korgenski, E. Kent; Daly, Judy A.; LaFleur, Bonnie; Pavia, Andrew T.; Byington, Carrie L.

doi:10.1016/j.ajic.2008.09.019

Cited by 40 publications

(39 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2,6 In addition, extended-spectrum ␤-lactamase and carbapenemase-producing E coli strains, such as were historically associated with nosocomial or health care-associated (HA) infections, are now prevalent in the community. 2,6,[12][13][14] Most studies that have examined antibiotic resistance among E coli isolates have included convenience samples, 1,2,4,5,[15][16][17][18][19] and only 2 have been population based. 20,21 Thus, it is unclear whether the increase in antibiotic-resistant E coli infections is disproportionately affecting specific patient groups.…”

Section: -11mentioning

confidence: 99%

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

Swami

Liesinger

Shah

et al. 2012

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Objective: To better understand the epidemiology of drug-resistant Escherichia coli across health care and community settings. Patients and Methods:We conducted a population-based cohort study of the incidence of antibiotic-resistant E coli bacteriuria among different patient groups. All urine cultures with monomicrobial growth of E coli obtained from Olmsted County, Minnesota, residents from January 1, 2005, through December 31, 2009, were identified. The initial isolate per patient per year was included. Analyses were stratified by patient age and location of infection onset (ie, nosocomial, health care associated, and community associated). Results: We evaluated 5619 E coli isolates and the associated patients. During the study period, the incidence of drug-resistant bacteriuria did not change among children but increased significantly among adults of all ages, most markedly among elderly patients older than 80 years. In elderly patients, the incidence of bacteriuria with isolates resistant to fluoroquinolones increased from 464 to 1116 per 100,000 person-years (PϽ.001), and the incidence of bacteriuria with isolates resistant to fluoroquinolones plus trimethoprim-sulfamethoxazole increased from 274 to 512 per 100,000 person-years (PϽ.05). When analyzed by location of infection onset, incidence of bacteriuria with isolates resistant to trimethoprim-sulfamethoxazole, fluoroquinolones, trimethoprim-sulfamethoxazole plus fluoroquinolones, extended-spectrum cephalosporins, and more than 3 drug classes increased significantly among communityassociated but not among nosocomial or health care-associated cases. Conclusion: In this population-based study, the incidence of antibiotic-resistant E coli bacteriuria nearly doubled during the 5-year study period among elderly patients and those with community-associated isolates. These patient groups should be targets of interventions to slow the emergence and spread of antibiotic-resistant E coli.

show abstract

Section: -11mentioning

confidence: 99%

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

Swami

Liesinger

Shah

et al. 2012

Mayo Clinic Proceedings

View full text Add to dashboard Cite

show abstract

“…In the neonatal period, most studies have focused on hospital-acquired colonization or infection with ESBLproducing E. coli strains (8), leaving aside the epidemiology of community carriage (9). It is necessary to know more about community-acquired infections and particularly about maternal-neonatal transmission to implement empirical therapy (e.g., use of carbapenems in maternity wards where the prevalence of ESBL-producing Enterobacteriaceae is high).…”

mentioning

confidence: 99%

Characterization of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli Strains Involved in Maternal-Fetal Colonization: Prevalence of E. coli ST131

et al. 2013

View full text Add to dashboard Cite

dMaternal-fetal Escherichia coli infections, such as neonatal bacteremia and meningitis, are important causes of morbidity and mortality. From 2006 to 2010, we studied newborns and their mothers who were colonized with E. coli in a French hospital in order to document (i) the epidemiology and genetic characteristics of extended-spectrum-beta-lactamase (ESBL)-producing E. coli strains, (ii) the prevalence of associated virulence genes, (iii) the prevalence of clone sequence type 131 (ST131), and (iv) the genetic relationship among ESBL-producing strains. Among the 2,755 E. coli cultures recovered from vaginal or neonatal samples, 68 were ESBL producers (2.46%). We found a wide diversity of ESBL genes, with the majority being bla CTX-M-14 , bla CTX-M-1 , and bla CTX-M-15 , distributed among the 4 main phylogenetic groups. Genes encoding virulence factors were found in 90.7% of the isolates, with >2 virulence genes present in 76% of cases. The prevalence of ST131 among ESBL-producing E. coli isolates was 9.4% (6/64). Five of these 6 ST131 isolates possessed bla CTX-M-15 enzymes (and also were resistant to quinolones), and one possessed bla CTX-M-2 enzymes. Two possessed virulence genes, suggesting the presence of pathogenicity island II J96 (PAI II J96 )-like domains. Pulsed-field gel electrophoresis (PFGE) revealed a high level of genomic diversity overall, except for 3 closely related isolates belonging to clonal group ST131. Repetitive PCR showed that the six ST131 isolates were closely related to ST131 control strains (>95% similarity). This study shows a high prevalence of ESBL-producing E. coli strains and clonal group ST131 in the French maternal-fetal population. These results suggest a widespread distribution of ESBL enzymes in the community and highlight the early transmission between mothers and neonates. These findings are worrisome, especially for this particularly vulnerable population. In the past decade, there has been an alarming increase in antibiotic-resistant Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs), due at least in part to the overuse of broad-spectrum cephalosporins.The majority of ESBLs identified in clinical isolates during the 1980s to 1990 were of the SHV or TEM type (1). However, since the mid-2000s, CTX-M ESBLs, originating from environmental Kluyvera spp., have gained prominence and are considered pandemic enzymes. CTX-M has been identified in several members of the Enterobacteriaceae family, and especially in Escherichia coli, which has replaced Klebsiella spp. as the principal ESBL-producing member of the Enterobacteriaceae (2-4).ESBL enzymes are important causes of cephalosporin treatment failure. E. coli strains carrying these enzymes were initially responsible mainly for nosocomial infections, but they have now disseminated into the community. One of the best examples of this trend is the global spread of E. coli clone sequence type 131 (ST131), expressing CTX-M enzymes (5). Maternal-fetal E. coli infections, such as neonatal bacteremia and meningitis,...

show abstract

“…The ESBL-producing K. pneumoniae rate was high in our study. Increasing ESBL production is an important problem in K. pneumoniae infections (3,20). Mechanical ventilation and hospitalization for more than 14 days have been reported to be the strongest independent predictors of ESBL-positive K. pneumoniae colonization in pediatric patients (21,22).…”

mentioning

confidence: 99%

“…In our study, E. coli was the responsible organism in one-third of nosocomial UTIs, and the ESBL-production rate was high. The antibiotic resistance of E. coli is also an increasing problem (20,22). Clinical sepsis and NP are well-known diagnoses that are not based on microbiological tests but are based on CDC criteria (2).…”

mentioning

confidence: 99%

Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey

Balaban¹,

Tanır²,

Timur³

et al. 2012

Jpn J Infect Dis

View full text Add to dashboard Cite

SUMMARY:The aims of this study were to determine the prevalence, type, and clinical features of nosocomial infections (NIs), their etiological distribution, and the antibiotic resistance patterns of causative organisms in the general pediatric wards of a hospital in Turkey over a 3-year period. The Hospital Infection Control Committee NI surveillance reports were used as a database. NIs were detected in 171 (2.25z) of the 7,594 hospitalized patients. Some of these patients experienced more than 1 episode, and thus, the total NI episodes were 229. Patients' age varied from 1 to 144 months (mean ± standard deviation, 14.5 ± 23.6 months). The NI rate was 3.02z, and the NI density was 3.17/1,000 patient days. The most frequent NIs were lower respiratory system infections, blood stream infections, and urinary tract infections. Gram-negative organisms were the most frequently isolated agents. Of the 171 patients with NIs, 47 (27.5z) died.Nosocomial infections (NIs) are the major causes of prolonged hospital stays, increased costs, the increased resistance of organisms to antimicrobials, and mortality in hospitalized adults and children. NIs in pediatric and adult patients differ with respect to the sites of infection and the types of pathogens. In addition, NIs differ by country, region, hospital, and type of units, such as wards or intensive care units (1). There exist many reports on epidemiology, risk factors, and preventive measures for adult NIs. However, studies that focus on the pediatric population, particularly in developing countries, are limited. For this reason, we investigated the epidemiological, microbiological, and clinical features of NIs in the general wards of a pediatric hospital that does not have a pediatric intensive care unit (PICU) facility.Immunocompetent patients who were aged from 1 month to 18 years and had been admitted for miscellaneous diseases and developed a NI between January 2005 and January 2008 in a hospital in Turkey were retrospectively evaluated. The patients who had positive bacterial culture results or had negative culture results but clinical features of infection were included. A positive blood culture that was taken at least 72 h after the preceding positive blood culture was assessed as a new NI episode. The Hospital Infection Control Committee (HICC) NI surveillance reports were used as the database. NIs were defined on the basis of the Centers for Disease Control and Prevention (CDC) criteria (2). Crude NI rates were calculated with the following formula: NI rate ＝ (infection number/admitted or discharged patient number) × 100, and NI density was caluculated with the following formula: density ＝ (infection number/patient day) × 1,000 for each year and ward. The ventilator-associated pneumonia (VAP) rate was calculated with the following formula: VAP rate ＝ (VAP number/mechanical ventilator day) × 1,000. The NIs of each patient were classified according to the infection sites. Standard methods were used for microbiologic, biochemical, and radiologic investigations. Antib...

show abstract

Extended-spectrum β-lactamase-producing pathogens in a children's hospital: A 5-year experience

Cited by 40 publications

References 34 publications

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

Incidence of Antibiotic-Resistant Escherichia coli Bacteriuria According to Age and Location of Onset: A Population-Based Study From Olmsted County, Minnesota

Characterization of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli Strains Involved in Maternal-Fetal Colonization: Prevalence of E. coli ST131

Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey

Contact Info

Product

Resources

About