The molecular and clinical epidemiology of extended- spectrum cephalosporin- and carbapenem-resistant Enterobacteriaceae at 4 US pediatric hospitals

Danielle M. Zerr, Scott J. Weissman, Chuan Zhou, Matthew P. Kronman, Amanda L. Adler, Jessica E. Berry, Jaipreet Rayar, Jeff Myers, Wren L. Haaland, Carey Ann D. Burnham, Alexis Elward, Jason Newland, Rangaraj Selvarangan, Kaede V. Sullivan, Theoklis Zaoutis, Xuan Qin

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective. In this report, we aim to describe the epidemiology of extended-spectrum cephalosporin-resistant (ESC-R) and carbapenem-resistant (CR) Enterobacteriaceae infections in children. Methods. ESC-R and CR Enterobacteriaceae isolates from normally sterile sites of patients aged < 22 years from 4 freestanding pediatric medical centers were collected along with the associated clinical data. Results. The overall frequencies of ESC-R and CR isolates according to hospital over the 4-year study period ranged from 0.7% to 2.8%. Rates of ESC-R or CR Escherichia coli and Klebsiella pneumoniae varied according to hospital and ranged from 0.75 to 3.41 resistant isolates per 100 isolates (P < .001 for any differences). E coli accounted for 272 (77%) of the resistant isolates; however, a higher rate of resistance was observed in K pneumoniae isolates (1.78 vs 1.27 resistant isolates per 100 same-species isolates, respectively; P = .005). One-third of the infections caused by ESC-R or CR E coli were community-associated. In contrast, infections caused by ESC-R or CR K pneumoniae were more likely than those caused by resistant E coli to be healthcare- or hospital-associated and to occur in patients with an indwelling device (P ≤ .003 for any differences, multivariable logistic regression). Nonsusceptibility to 3 common non-β-lactam agents (ciprofloxacin, gentamicin, and trimethoprim-sulfamethoxazole) occurred in 23% of the ESC-R isolates. The sequence type 131-associated fumC/fimH-type 40-30 was the most prevalent sequence type among all resistant E coli isolates (30%), and the clonal group 258-associated allele tonB79 was the most prevalent allele among all resistant K pneumoniae isolates (10%). Conclusions. The epidemiology of ESC-R and CR Enterobacteriaceae varied according to hospital and species (E coli vs K pneumoniae). Both community and hospital settings should be considered in future research addressing pediatric ESC-R Enterobacteriaceae infection.

Original languageEnglish
Pages (from-to)366-375
Number of pages10
JournalJournal of the Pediatric Infectious Diseases Society
Issue number4
StatePublished - Dec 1 2017


  • Enterobacteriaceae
  • Pediatrics
  • Resistance


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