Toubiana Julie, Timsit Sandra, Ferroni Agnès, Grasseau Marie, Nassif Xavier, Lortholary Olivier, Zahar Jean-Ralph, Chalumeau Martin
From the Department of General Pediatrics and Pediatric Infectious Disease (JT, MG, MC); Department of Pediatric Emergency (ST); Department of Microbiology (AF, XN, J-RZ); Department of Infectious Diseases and Tropical Medicine (OL), Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université Paris Descartes, IHU Imagine, Paris; and Unité de Prévention et de Lutte contre les Infections Nosocomiales (J-RZ), CHU d'Angers, Université d'Angers, Angers, France.
Medicine (Baltimore). 2016 Mar;95(12):e3163. doi: 10.1097/MD.0000000000003163.
Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.
关于产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）所致儿童社区获得性感染的数据有限，但此类感染可能影响经验性抗生素治疗的疗效以及抗生素的合理使用。我们回顾性分析了2007年至2012年期间法国一家三级医院收治的所有16岁及以下儿童的数据，这些儿童在入院48小时内通常无菌部位的标本中分离出ESBL-PE菌株阳性。我们分析了社区获得性感染中与医疗保健相关和社区相关的感染情况。总共收集了3612株肠杆菌科细菌分离株；在研究期间，ESBL-PE感染的患病率从2.4%增至5.1%（P<0.001）。在90例首次发生社区获得性ESBL-PE感染的儿童中，58%（n=52）为与医疗保健相关的感染，87%的分离株对阿米卡星敏感。与社区相关感染的患者相比，与医疗保健相关感染的患者尿路感染（UTIs）较少（86%对97%）、大肠杆菌感染较少（35%对84%），而肺炎克雷伯菌感染较多（46%对8%）。54例患者（64%）接受了不恰当的经验性治疗，但49例UTI患者中有46例（94%）以及5例非UTI患者中有1例（20%）观察到了良好的结局（P<0.001）。在社区相关感染的患者中，85%至少有1个ESBL-PE感染的危险因素。总之，在研究期间社区获得性ESBL-PE感染的患病率增加了一倍。这些感染主要发生在符合医疗保健相关标准或已确定危险因素的儿童中。阿米卡星可作为碳青霉烯类药物经验性治疗的替代药物，因为这些感染大多累及泌尿系统且分离株敏感。
