Intestinal Carriage of Third-Generation Cephalosporin-Resistant and Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Healthy US Children

Details

• Alternative Title:
  J Pediatric Infect Dis Soc
• Personal Author:
  Islam, Shamim ; Selvarangan, Rangaraj ; Kanwar, Neena ; McHenry, Rendie ; Chappell, James D. ; Halasa, Natasha ; Wikswo, Mary E. ; Payne, Daniel C. ; Azimi, Parvin H. ; McDonald, L. Clifford ; Gomez-Duarte, Oscar G.
• Description:
  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.
  
  
• Subjects:
  Adolescent Anti-Bacterial Agents Beta-Lactamases Carrier State Cephalosporin Resistance Child Child, Preschool Enterobacteriaceae Enterobacteriaceae Infections Feces Hospitalization Humans Infant Intestines Prevalence Risk Factors Travel-Related Illness

  More +
• Source:
  J Pediatric Infect Dis Soc. 7(3):234-240
• Pubmed ID:
  28992133
• Pubmed Central ID:
  PMC5820225
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States ; U01 IP000463/IP/NCIRD CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  7
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7cb49ac47b2a1db5f61c53f48dd37a0e7183f1c92cd66f4612c87adc7bd71736
• Download URL:
  https://stacks.cdc.gov/view/cdc/52041/cdc_52041_DS1.pdf
• File Type:
  [PDF - 340.69 KB ]