Department of Pediatrics, Maimonides Infants & Children's Hospital of Brooklyn, Brooklyn, NY, USA.
Department of Pediatrics, Maimonides Infants & Children's Hospital of Brooklyn, Brooklyn, NY, USA; Division of Pediatric Infectious Diseases, Maimonides Infants & Children's Hospital of Brooklyn, Brooklyn, NY, USA.
Travel Med Infect Dis. 2016 Nov-Dec;14(6):568-571. doi: 10.1016/j.tmaid.2016.11.012. Epub 2016 Nov 24.
Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) infections are increasing in both adults and children. The aim of this study was to describe the epidemiology of children with ESBL in an ethnically-diverse population, to determine what proportion of these infections were community-onset, and to identify risk factors predisposing children to ESBL acquisition.
A case-case-control study of children aged 0-18 years was conducted from 2012 to 2014. Patients with ESBL (detected via VITEK2) were matched 1:1:5 (based on age, sex, specimen source, and healthcare setting) with non-ESBL and uninfected controls. Data on prior antibiotic and healthcare exposure, international travel, prior urinary tract infection (UTI), comorbid gastrointestinal (GI), genitourinary (GU), neurologic, and immunocompromising conditions were collected and compared.
Seventy-six patients were identified with 85 ESBL infections, of which 77 (91%) were E. coli. ESBL was isolated most frequently from urine (n = 72, 85%). Most infections were community-onset (n = 76, 89%) and were managed in the ambulatory setting (n = 47, 62%). On multivariate analysis, international travel (p < 0.001, OR 8.93; CI 2.92-27.78), comorbid GI condition (p = 0.002, OR 2.65, CI 1.36-5.15), Asian race (p = 0.005, OR 2.56, CI 1.34-4.89) and prior UTI (p < 0.001, OR 8.06, CI 3.47-18.87) were significant risk factors for ESBL.
Most ESBL infections in this study were community-onset. To our knowledge, this is the first description of international travel as a risk factor for ESBL acquisition in children in the United States.
产超广谱β-内酰胺酶肠杆菌科（ESBL）感染在成人和儿童中都呈上升趋势。本研究的目的是描述在种族多样化的人群中儿童 ESBL 的流行病学情况，确定这些感染中有多少是社区获得性的，并确定使儿童易感染 ESBL 的危险因素。
对 2012 年至 2014 年期间年龄在 0-18 岁的儿童进行病例对照研究。通过 VITEK2 检测出 ESBL（检测出）的患者与非 ESBL 和未感染对照者 1:1:5 配对（基于年龄、性别、标本来源和医疗保健环境）。收集并比较了既往抗生素和医疗保健暴露、国际旅行、既往尿路感染（UTI）、合并胃肠道（GI）、泌尿生殖系统（GU）、神经和免疫抑制性疾病的情况。
共发现 76 例患者，85 例 ESBL 感染，其中 77 例（91%）为大肠杆菌。ESBL 最常从尿液中分离（n=72，85%）。大多数感染为社区获得性（n=76，89%），并在门诊治疗（n=47，62%）。多变量分析显示，国际旅行（p<0.001，OR 8.93；CI 2.92-27.78）、合并 GI 疾病（p=0.002，OR 2.65，CI 1.36-5.15）、亚洲种族（p=0.005，OR 2.56，CI 1.34-4.89）和既往 UTI（p<0.001，OR 8.06，CI 3.47-18.87）是 ESBL 的显著危险因素。
本研究中大多数 ESBL 感染为社区获得性。据我们所知，这是首次在美国描述国际旅行是儿童获得 ESBL 的危险因素。
