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. 2019 Jun;8(2):243-254.
doi: 10.1007/s40121-019-0237-2. Epub 2019 Feb 16.

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

Latania K Logan  1   2   3 , Rachel L Medernach  4   5 , T Nicholas Domitrovic  6   7 , Jared R Rispens  4   5 , Andrea M Hujer  6   7 , Nadia K Qureshi  8 , Steven H Marshall  6 , David C Nguyen  4   7   5 , Susan D Rudin  6 , Xiaotian Zheng  9   10 , Sreenivas Konda  11 , Robert A Weinstein  5   12 , Robert A Bonomo  6   7   13   14   15   16
Affiliations

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

Latania K Logan et al. Infect Dis Ther. 2019 Jun.

Abstract

Introduction: The pandemic of extended-spectrum beta-lactamase-(ESBL)-producing Enterobacteriaceae (Ent) is strongly linked to the dissemination of CTX-M-type-ESBL-Ent. We sought to define the epidemiology of infections in children due to an emerging resistance type, CTX-M-9-group-producing-Ent (CTX-M-9-grp-Ent).

Methods: A retrospective matched case-control analysis of children with CTX-M-9-grp-Ent infections who received medical care at three Chicago area hospitals was performed. Cases were defined as children possessing extended-spectrum cephalosporin-resistant (ESC-R) infections due to blaCTX-M-9. PCR and DNA analysis assessed beta-lactamase (bla) genes, multi-locus sequence types (MLST) and phylogenetic grouping of E. coli. Controls were children with ESC-susceptible (ESC-S)-Ent infections matched one case to three controls by age, source, and hospital. The clinical-epidemiologic predictors of CTX-M-9-grp-Ent infection were assessed.

Results: Of 356 ESC-R-Ent isolates from children (median age 4.1 years), the CTX-M-9-group was the solely detected bla gene in 44 (12.4%). The predominant species was E. coli (91%) of virulent phylogroups D (60%) and B2 (40%). MLST revealed multiple strain types. On multivariable analysis, CTX-M-9-grp-Ent occurred more often in E. coli than other Ent genera (OR 7.4, 95% CI 2.4, 27.2), children of non-Black-White-Hispanic race (OR 7.4, 95% CI 2.4, 28.2), and outpatients (OR 4.5, 95% CI 1.7, 12.3), which was a very unexpected finding for infections due to antibiotic-resistant bacteria. Residents of South Chicago had a 6.7 times higher odds of having CTX-M-9-grp-Ent infections than those in the reference region (West), while residence in Northwestern Chicago was associated with an 81% decreased odds of infection. Other demographic, comorbidity, invasive-device, and antibiotic use differences were not found.

Conclusion: CTX-M-9-grp-Ent infection may be associated with patient residence and is occurring in children without traditional in-patient exposure risk factors. This suggests that among children, the community environment may be a key contributor in the spread of these resistant pathogens.

Keywords: Children; Drug resistance; Enterobacteriaceae infections; Epidemiology; Gram-negative bacteria.

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References

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    1. Medernach RL, Logan LK. The growing threat of antibiotic resistance in children. Infect Dis Clin N Am. 2018;32(1):1–17. doi: 10.1016/j.idc.2017.11.001. - DOI - PMC - PubMed
    1. Lukac PJ, Bonomo RA, Logan LK. Extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: old foe, emerging threat. Clin Infect Dis. 2015;60(9):1389–1397. - PMC - PubMed
    1. Logan LK, Renschler JP, Gandra S, Weinstein RA, Laxminarayan R, Centers for Disease Control et al. Carbapenem-resistant Enterobacteriaceae in children, United States, 1999–2012. Emerg Infect Dis. 2015;21(11):2014–2021. doi: 10.3201/eid2111.150548. - DOI - PMC - PubMed
    1. Logan LK, Braykov NP, Weinstein RA, Laxminarayan R, CDC Epicenters Prevention Program Extended-spectrum beta-lactamase-producing and third-generation cephalosporin-resistant enterobacteriaceae in children: trends in the United States, 1999–2011. J Pediatr Infect Dis Soc. 2014;3(4):320–328. doi: 10.1093/jpids/piu010. - DOI - PubMed