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Meta-Analysis
. 2017 Jan 31;12(1):e0171216.
doi: 10.1371/journal.pone.0171216. eCollection 2017.

Prevalence of ESBL-Producing Enterobacteriaceae in Pediatric Bloodstream Infections: A Systematic Review and Meta-Analysis

Myrto Eleni Flokas  1 , Styliani Karanika  1 , Michail Alevizakos  1 , Eleftherios Mylonakis  1
Affiliations
Meta-Analysis

Prevalence of ESBL-Producing Enterobacteriaceae in Pediatric Bloodstream Infections: A Systematic Review and Meta-Analysis

Myrto Eleni Flokas et al. PLoS One. .

Abstract

Background: Pediatric bloodstream infections (BSIs) with Extended-Spectrum Beta-Lactamase- producing Enterobacteriaceae (ESBL-PE) are associated with worse clinical outcomes. We aimed to estimate the prevalence of and the mortality associated with ESBL-PE in this patient population.

Methods: A systematic review and meta-analysis using PubMed and EMBASE and included studies reporting the prevalence of ESBL-PE among confirmed BSIs in patients <19 years old.

Results: Twenty three (out of 1,718 non-duplicate reports) studies that provided data on 3,381 pediatric BSIs from 1996 to 2013 were included. The prevalence of ESBL-PE was 9% [95%CI (6, 13)] with an annual increase of 3.2% (P = 0.04). The prevalence was 11% [95%CI (6, 17)] among neonates, compared to 5% [95%CI (0, 14)] among children older than 28 days. The pooled prevalence was 15% in Africa [95%CI (8, 23)], 12% in South America [95%CI (5, 23)], 11% in India [95%CI (7, 17)], 7% in the rest of Asia [95%CI (0, 22)], 4% in Europe [95%CI (1, 7)] and 0% in Oceania [95%CI (0, 3)]. Importantly, the mortality in neonates with BSI due to ESBL-PE was 36% [95%CI (22, 51)], compared to 18% [95%CI (15, 22)] among all other neonates with BSI and this difference was statistically significant (P = 0.01).

Conclusions: In the pediatric population, the prevalence of BSI due to ESBL-PE is significant and is associated with increased mortality in neonates. Further studies are warranted to establish a high-risk group and the evaluation of preventive measures, such as antibiotic stewardship programs and infection control measures, in this population is urgently needed.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
Fig 2
Fig 2
Prevalence of ESBL-PE among laboratory-confirmed bloodstream infections in pediatric patients: forest plot of included studies and geographical distribution.
Fig 3
Fig 3. Time trend of ESBL-PE laboratory-confirmed bloodstream infections (1996–2013) depicting annual increase of 3.2%.
Circles illustrate the estimates from each study, sized proportionately to the precision of each estimate. The fitted regression line is represented by study midyear.
Fig 4
Fig 4. Mortality among neonates with ESBL-PE and non-ESBL-PE LCBSI.
Forest plot of risk difference (RD).
See this image and copyright information in PMC

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