健康美国儿童中产第三代头孢菌素耐药和产超广谱β-内酰胺酶肠杆菌科的肠道携带情况。
Intestinal Carriage of Third-Generation Cephalosporin-Resistant and Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Healthy US Children.
机构信息
University at Buffalo, State University of New York.
Children's Mercy Hospital, Kansas City, Missouri.
出版信息
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):234-240. doi: 10.1093/jpids/pix045.
BACKGROUND
The epidemiology of antibiotic-resistant Enterobacteriaceae intestinal carriage in healthy US children has not been well characterized.
METHODS
Children between 14 days and 14 years of age were enrolled during well-child visits in Oakland, California, Kansas City, Kansas, and Nashville, Tennessee, between December 2013 and March 2015. Data on recent antibiotic use by the child and travel and hospitalization history of all members of each child's household were obtained with a risk-factor survey. Stool specimens collected from the subjects were screened for extended-spectrum β-lactamase-producing (ESBL-P) bacteria using CHROMagar ESBL medium. Putative ESBL-P Escherichia coli and Klebsiella colonies underwent phenotypic confirmation by double-disk synergy testing; confirmed third-generation cephalosporin-resistant (3GCR) isolates underwent additional antibiotic-susceptibility testing.
RESULTS
In 519 subjects, the overall 3GCR Enterobacteriaceae carriage rate was 4.4% (n = 23) and ranged from 3.4% to 5.1% among the study sites. The ESBL-P Enterobacteriaceae carriage rate was 3.5% (n = 18). The rates of 3GCR Enterobacteriaceae carriage was highest in 1 to <2 year olds at 6.5%, and was 5.2% in <5 year-olds vs 1.7% in ≥5-year-olds (P = .11). 3GCR and ESBL-P Enterobacteriaceae carriage was associated with international travel within the previous year; 11.1% of ESBL-P Enterobacteriaceae carriers reported this history compared with 1.6% of noncarriers (P = .004). No other queried factor was found to increase risk. Of the 24 analyzed 3GCR isolates, 58% were multidrug resistant.
CONCLUSIONS
The 3GCR Enterobacteriaceae carriage rate exceeds 5% in healthy US children <5 years of age. International travel within the previous year increased the risk of 3GCR and ESBL-P Enterobacteriaceae carriage. In contrast, we found no differences in the rates of hospitalization or recent antibiotic exposure between carriers and noncarriers. Young children, who have the highest prevalence of colonization, might be a sentinel population to study to gain a better understanding of community sources of antibiotic-resistant Enterobacteriaceae.
背景
美国健康儿童肠道中携带抗生素耐药肠杆菌科的流行病学情况尚未得到很好的描述。
方法
2013 年 12 月至 2015 年 3 月，在加利福尼亚州奥克兰、堪萨斯州堪萨斯城和田纳西州纳什维尔，对 14 天至 14 岁的儿童进行了健康儿童就诊时的入组。通过危险因素调查获得了儿童最近使用抗生素的情况以及每个儿童家庭所有成员的旅行和住院史的数据。使用 CHROMagar ESBL 培养基从受试者中采集的粪便标本筛查产超广谱β-内酰胺酶（ESBL-P）细菌。对推定的 ESBL-P 大肠埃希菌和克雷伯菌进行了双碟协同试验进行表型确认；对确认为第三代头孢菌素耐药（3GCR）的分离株进行了进一步的抗生素药敏试验。
结果
在 519 名受试者中，总体 3GCR 肠杆菌科携带率为 4.4%（n=23），研究地点的携带率范围为 3.4%至 5.1%。ESBL-P 肠杆菌科携带率为 3.5%（n=18）。1 至<2 岁儿童的 3GCR 肠杆菌科携带率最高，为 6.5%，<5 岁儿童为 5.2%，≥5 岁儿童为 1.7%（P=0.11）。3GCR 和 ESBL-P 肠杆菌科携带与前一年的国际旅行有关；11.1%的 ESBL-P 肠杆菌科携带者有此病史，而非携带者为 1.6%（P=0.004）。没有发现其他询问因素会增加风险。在分析的 24 株 3GCR 分离株中，58%为多药耐药。
结论
3GCR 肠杆菌科在<5 岁的美国健康儿童中的携带率超过 5%。前一年的国际旅行增加了 3GCR 和 ESBL-P 肠杆菌科携带的风险。相比之下，我们在携带者和非携带者之间没有发现住院或最近使用抗生素的比例有差异。幼儿的定植率最高，可能是研究社区来源的抗生素耐药肠杆菌科的一个哨点人群。
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