Extended-Spectrum β-Lactamase-Producing and Third-Generation Cephalosporin-Resistant Enterobacteriaceae in Children: Trends in the United States, 1999-2011
Extended-Spectrum β-Lactamase-Producing and Third-Generation Cephalosporin-Resistant Enterobacteriaceae in Children: Trends in the United States, 1999-2011
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DOI：
10.1093/jpids/piu010
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发表时间：
2014-12-01
影响因子：
3.2
通讯作者：
Laxminarayan, Ramanan
中科院分区：
文献类型：
--
作者：
Logan, Latania K.;Braykov, Nikolay P.;Laxminarayan, Ramanan
背景。对广谱β-内酰胺具有抗药性的肠杆菌科感染是儿童中一个新出现的问题。我们使用大型临床分离数据库来描述产超广谱 β-内酰胺酶 (ESBL) 和第三代头孢菌素耐药 (G3CR) 肠杆菌科细菌的全国流行病学。方法。 1999 年 1 月至 2011 年 12 月期间，参与监测网络 (TSN) 的 300 个实验室报告了肺炎克雷伯菌、大肠杆菌和奇异变形杆菌的抗菌敏感性，用于表型鉴定从 18 岁以下患者中培养的 G3CR 和 ESBL 分离株。每种表型患病率的半年趋势按物种、患者所在地、培养地点、年龄和地区进行分层。 0-1 岁儿童被排除在分析之外，因为数据仅从 2010 年开始提供。结果。在 368,398 株儿童分离株中，1.97%（7255 株）被鉴定为 G3CR，0.47%（1734 株）被鉴定为 ESBL 产生者。两种表型的患病率分别从1999-2001年的1.39%和0.28%增加到2010-2011年的3%和0.92%。所有人口和年龄组（包括门诊患者）的趋势都很显着，其中 1-5 岁年龄组的分离株比例最高。大多数 G3CR 和 ESBL 分离株是大肠杆菌（分别为 67.8% 和 65.2%）。在 ESBL 中，对 >= 3 类抗生素的耐药率为 74%。中西部地区上游地区产 ESBL 细菌的流行率低于全国其他地区，这与最近的当地数据一致。结论。全国住院和门诊儿童 G3CR 和 ESBL 感染率均呈上升趋势。识别导致儿童感染的宿主因素和暴露至关重要。
Background. Enterobacteriaceae infections resistant to extended-spectrum beta-lactams are an emerging problem in children. We used a large database of clinical isolates to describe the national epidemiology of extended-spectrum beta-lactamase (ESBL)-producing and third-generation cephalosporin-resistant (G3CR) Enterobacteriaceae.Methods. Antimicrobial susceptibilities of Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis reported to similar to 300 laboratories participating in The Surveillance Network (TSN) between January 1999 and December 2011 were used to phenotypically identify G3CR and ESBL isolates cultured from patients < 18 years. Bi-annual trends in the prevalence of each phenotype were stratified by species, patient location, culture site, age, and region. Children of age 0-1 years were excluded from analysis as data were only available from 2010 onwards.Results. Out of 368,398 pediatric isolates, 1.97% (7255) were identified as G3CR, and 0.47% (1734) as ESBL producers. The prevalence of both phenotypes increased, respectively, from 1.39% and 0.28% in 1999-2001 to 3% and 0.92% in 2010-2011. Trends were significant across all demographic and age groups, including outpatients, with the highest proportion of isolates in the 1-5-year-old age group. The majority of G3CR and ESBL isolates were E. coli (67.8% and 65.2%, respectively). Among ESBLs, resistance to >= 3 antibiotic classes was 74%. The lower regional prevalence of ESBL-producing bacteria in the upper Midwest relative to the rest of the country is consistent with recent local data.Conclusions. Rates of G3CR and ESBL infections in children are increasing in both inpatient and ambulatory settings nationally. The identification of host factors and exposures leading to infection in children is essential.