Pediatric Carbapenem-resistant Enterobacteriaceae in Los Angeles, California, a High-prevalence Region in the United States

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Pannaraj, Pia S. ; Bard, Jennifer Dien ; Cerini, Chiara ; Weissman, Scott J.
• Description:
  Background
  
  Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are on the rise worldwide but are not well described in pediatric populations. This study characterizes the clinical, phenotypic and genotypic characteristics of CRE infections at a free-standing US children's hospital.
  
  Methods
  
  CRE were defined as any clinical Enterobacteriaceae isolate non-susceptible to either imipenem or meropenem and resistant to ceftriaxone, cefotaxime and ceftazidime determined by routine antimicrobial susceptibility testing. The modified Hodge test was performed to screen for the production of carbapenemase. Clinical data were reviewed, and molecular characterization of phylogenetic and resistance-associated traits was performed.
  
  Results
  
  CRE isolates were recovered from sterile and non-sterile sites in 10 patients, 6 weeks to 24 years of age, between 2011 and 2013. Comorbidities included hematologic, genetic and urologic abnormalities. Two patients had traveled abroad (India, Lebanon) before CRE recovery. Carbapenemase determinants were detected in 5 cases, including KPC-3 in 2 Klebsiella pneumoniae (ST258 and ST18) and 1 Escherichia coli (ST131), and NDM-1 in 1 K. pneumoniae (ST37) and 1 E. coli (ST101) isolate. Additional resistance determinants were detected, including CTX-M-15, SHV-11, TEM-1, CMY-2, CMY-4 and CMY-42. Four patients died, including 2 of 3 patients with CRE bacteremia. There was no evidence of epidemiologic or molecular relatedness between any 2 cases.
  
  Conclusions
  
  This report documents the appearance of highly resistant Gram-negative pathogens in a vulnerable patient population at a pediatric tertiary referral center in a major US metropolitan area. Detailed understanding of the distribution and spread of CRE is essential for the timely detection and containment of these perilous pathogens.
  
  
• Subjects:
  Article Carbapenemase Gram-negative Rods Klebsiella Pneumoniae Carbapenemase Los Angeles Multidrug Resistance New Delhi Metallo-beta-lactamase
• Source:
  Pediatr Infect Dis J. 2014; 34(1):11-16.
• Pubmed ID:
  25093977
• Pubmed Central ID:
  PMC4437704
• Document Type:
  Journal Article
• Funding:
  5 K23 HD072774-02/HD/NICHD NIH HHS/United States ; K23 HD072774/HD/NICHD NIH HHS/United States ; R01 AI083413/AI/NIAID NIH HHS/United States ; U50 CK000187/CK/NCEZID CDC HHS/United States ; U50CK000187/CK/NCEZID CDC HHS/United States
• Volume:
  34
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8184c29ddd0fabbdf93ec7f9e7dee60ad0ac67034ffbddf636bf1d62f5817c24
• Download URL:
  https://stacks.cdc.gov/view/cdc/31130/cdc_31130_DS1.pdf
• File Type:
  [PDF - 356.92 KB ]