Multicenter study of the risk factors for colonization or infection with carbapenem-resistant Enterobacteriaceae in children

Kathleen Chiotos, Pranita Tamma, Kelly B. Flett, Matthew Naumann, Manjiree V. Karandikar, Warren B. Bilker, Theoklis Zaoutis, Jennifer H. Han

Research output: Contribution to journalArticle

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly identified in children in the United States, but data on the epidemiology of CRE in this population are limited. The objectives of this study were to characterize the risk factors for colonization or infection with CRE and describe the microbiologic characteristics of pediatric CRE isolates. We performed a multicenter matched case-control study from January 2011 to October 2015 at three tertiary care pediatric centers. Case patients were hospitalized children with CRE isolated from clinical cultures and were matched in a 2:1 ratio to control patients with carbapenem-susceptible Enterobacteriaceae (CSE). Risk factors for colonization or infection with CRE were then evaluated using a multivariable conditional logistic regression. Additionally, we comprehensively reported the antimicrobial susceptibility pattern for CRE isolates. Sixty-three case patients were identified and matched to 126 control patients. On multivariable analysis, antipseudomonal antibiotic exposure within the previous 3 months (odds ratio [OR], 5.20; 95% confidence interval [CI], 1.71 to 15.9; P 0.004), prior surgery (OR, 6.30; 95% CI, 1.83 to 21.6; P 0.003), and mechanical ventilation (OR, 12.4; 95% CI, 1.26 to 122; P 0.031) were identified as risk factors for colonization or infection with CRE. Pediatric CRE isolates demonstrated relatively low rates of resistance to amikacin (5%) and ciprofloxacin (25%). Our findings support an important role for antibiotic stewardship interventions limiting the unnecessary use of antipseudomonal antibiotics as a strategy to prevent widespread emergence of CRE in children. Future studies should further characterize molecular determinants of antibiotic resistance among pediatric CRE isolates.

Original languageEnglish (US)
Article numbere01440
JournalAntimicrobial Agents and Chemotherapy
Volume61
Issue number12
DOIs
StatePublished - Dec 1 2017

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Carbapenems
Enterobacteriaceae
Multicenter Studies
Infection
Pediatrics
Odds Ratio
Confidence Intervals
Anti-Bacterial Agents
Hospitalized Child
Amikacin
Ciprofloxacin
Microbial Drug Resistance
Artificial Respiration
Tertiary Care Centers
Case-Control Studies
Epidemiology
Logistic Models

Keywords

  • Gram-negative resistance
  • Klebsiella pneumoniae carbapenemase
  • Multidrug-resistant organism
  • Pediatrics

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Multicenter study of the risk factors for colonization or infection with carbapenem-resistant Enterobacteriaceae in children. / Chiotos, Kathleen; Tamma, Pranita; Flett, Kelly B.; Naumann, Matthew; Karandikar, Manjiree V.; Bilker, Warren B.; Zaoutis, Theoklis; Han, Jennifer H.

In: Antimicrobial Agents and Chemotherapy, Vol. 61, No. 12, e01440, 01.12.2017.

Research output: Contribution to journalArticle

Chiotos, Kathleen ; Tamma, Pranita ; Flett, Kelly B. ; Naumann, Matthew ; Karandikar, Manjiree V. ; Bilker, Warren B. ; Zaoutis, Theoklis ; Han, Jennifer H. / Multicenter study of the risk factors for colonization or infection with carbapenem-resistant Enterobacteriaceae in children. In: Antimicrobial Agents and Chemotherapy. 2017 ; Vol. 61, No. 12.
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abstract = "Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly identified in children in the United States, but data on the epidemiology of CRE in this population are limited. The objectives of this study were to characterize the risk factors for colonization or infection with CRE and describe the microbiologic characteristics of pediatric CRE isolates. We performed a multicenter matched case-control study from January 2011 to October 2015 at three tertiary care pediatric centers. Case patients were hospitalized children with CRE isolated from clinical cultures and were matched in a 2:1 ratio to control patients with carbapenem-susceptible Enterobacteriaceae (CSE). Risk factors for colonization or infection with CRE were then evaluated using a multivariable conditional logistic regression. Additionally, we comprehensively reported the antimicrobial susceptibility pattern for CRE isolates. Sixty-three case patients were identified and matched to 126 control patients. On multivariable analysis, antipseudomonal antibiotic exposure within the previous 3 months (odds ratio [OR], 5.20; 95{\%} confidence interval [CI], 1.71 to 15.9; P 0.004), prior surgery (OR, 6.30; 95{\%} CI, 1.83 to 21.6; P 0.003), and mechanical ventilation (OR, 12.4; 95{\%} CI, 1.26 to 122; P 0.031) were identified as risk factors for colonization or infection with CRE. Pediatric CRE isolates demonstrated relatively low rates of resistance to amikacin (5{\%}) and ciprofloxacin (25{\%}). Our findings support an important role for antibiotic stewardship interventions limiting the unnecessary use of antipseudomonal antibiotics as a strategy to prevent widespread emergence of CRE in children. Future studies should further characterize molecular determinants of antibiotic resistance among pediatric CRE isolates.",
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