Extended-Spectrum b-Lactamase-Producing Enterobacteriaceae Infections in XXXX : A Two-Center Case-Case-Control Study of Risk Factors and Outcomes in Chicago, Illinois.

@entity1 @entity795 @entity2348 @entity281 @entity4005 @entity526
BACKGROUND: Extended-spectrum b-lactamase (ESBL)-producing Enterobacteriaceae @entity281 are an emerging problem in @entity1 . We sought to identify risk factors and describe outcomes associated with pediatric ESBL-producing @entity2348 at 2 hospitals in Chicago, IL from 2008 to 2011. METHODS: A case-case-control study of @entity1 aged 0-17 years was conducted. Cases of @entity526 , @entity4005 , and @entity795 spp. ESBL-producing @entity2348 (n = 30) were compared to uninfected controls and in parallel, cases of non-ESBL-producing @entity2348 (n = 30) were compared to uninfected controls (n = 60). We then qualitatively compared these results. RESULTS: Median age of cases was 1.06 years; 62% of isolates were from urine, and 60% were @entity526 . By multivariable analysis, ESBL cases were 5.7 and 3.3 times more likely to have gastrointestinal (P = .001; 95% confidence interval [CI] 1.9-17.0) and neurologic (P = .001; 95% CI 1.1-3.7) comorbidities, respectively, than controls; non-ESBL cases were also more likely to have gastrointestinal comorbidities than controls (P = .014; odds ratio 3.6; 95% CI 1.2-10.1). Study period prevalence remained stable (1.7%). Most (60%) @entity281 occurred in the intensive care unit; however, 30% of @entity1 presented in the outpatient setting. Seventy-seven percent of isolates were multidrug resistant (ie, resistant to >= 3 antibiotic classes). Recurrence of @entity281 occurred in 17% of ESBL cases. Crude mortality rates (7%) did not differ between cases and controls. CONCLUSIONS: The incidence of @entity281 due to ESBL-positive Enterobacteriaceae was stable at 2 large tertiary-care medical centers over a 4-year period. Multidrug resistance in pediatric ESBL isolates is common. Risk factors for @entity281 due to ESBL-producing bacteria include neurologic medical conditions.
