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Volume 30, Number 6—June 2024
CME ACTIVITY - Research

Carbapenem-Resistant and Extended-Spectrum β-Lactamase–Producing Enterobacterales in Children, United States, 2016–2020

Heather N. GromeComments to Author , Julian E. Grass, Nadezhda Duffy, Sandra N. Bulens, Uzma Ansari, Davina Campbell, Joseph D. Lutgring, Amy S. Gargis, Thao Masters, Alyssa G. Kent, Susannah L. McKay, Gillian Smith, Lucy E. Wilson, Elisabeth Vaeth, Bailey Evenson, Ghinwa Dumyati, Rebecca Tsay, Erin Phipps, Kristina Flores, Christopher D. Wilson, Christopher A. Czaja, Helen Johnston, Sarah J. Janelle, Ruth Lynfield, Sean O’Malley, Paula Snippes Vagnone, Meghan Maloney, Joelle Nadle, and Alice Y. Guh
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (H.N. Grome, J.E. Grass, N. Duffy, S.N. Bulens, U. Ansari, D. Campbell, J.D. Lutgring, A.S. Gargis, T. Masters, A.G. Kent, S.L. McKay, A.Y. Guh); Foundation for Atlanta Veterans Education and Research, Decatur, Georgia, USA (G. Smith); Atlanta Veterans Affairs Medical Center, Decatur (G. Smith); Maryland Department of Health, Baltimore, Maryland, USA (L.E. Wilson, E. Vaeth, B. Evenson); New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York, USA (G. Dumyati, R. Tsay); University of New Mexico, Albuquerque, New Mexico, USA (E. Phipps, K. Flores); New Mexico Emerging Infections Program, Santa Fe, New Mexico, USA (E. Phipps, K. Flores); Tennessee Department of Health, Nashville, Tennessee, USA (C.D. Wilson); Colorado Department of Public Health and Environment, Denver, Colorado, USA (C.A. Czaja, H. Johnston, S.J. Janelle); Minnesota Department of Health, St. Paul, Minnesota, USA (R. Lynfield, S. O’Malley, P. Snippes Vagnone); Connecticut Department of Public Health, Hartford, Connecticut, USA (M. Maloney); California Emerging Infections Program, Oakland, California, USA (J. Nadle)

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Table 3

Demographic and clinical characteristics of cases with CRE and ESBL-E infections, United States*

Characteristic
CRE, 2016–2020
ESBL-E, 2019–2020†
p value
Demographic n = 159 n = 207
Sex <0.01
F 94 (59.1) 165 (79.7)
M 64 (40.3) 41 (19.8)
Unknown 1 (0.6) 1 (0.5)
Age group, y <0.01
Median, IQR 5 (1–10) 6 (2–15)
<1 35 (22.0) 30 (14.5)
1–3 30 (18.9) 40 (19.3)
4–9 47 (29.6) 56 (27.1)
10–14 28 (17.6) 27 (13.0)
15–17 19 (12.0) 54 (26.1)
Race 0.62
White 79 (50.0) 92 (44.4)
Black 29 (18.2) 25 (12.1)
Other 14 (8.8) 16 (7.7)
Unknown 37 (23.3) 74 (35.8)
Ethnicity 0.89
Hispanic 43 (27.0) 45 (21.7)
Non-Hispanic 86 (54.1) 96 (46.4)
Unknown
30 (18.9)
66 (31.9)
Clinical‡
Underlying conditions§ n = 158 n = 169
Premature birth 20 (12.7) 11 (6.5) 0.06
Diabetes mellitus 0 2 (1.2) 0.27
Neurologic condition, any 34 (21.5) 20 (11.8) 0.02
Urinary tract problems/abnormalities 42 (26.6) 22 (13.0) <0.01
Cardiovascular disease 13 (8.2) 3 (1.8) <0.01
Chronic pulmonary disease 25 (15.8) 21 (12.4) 0.38
Chronic renal disease 24 (15.2) 3 (1.8) <0.01
Gastrointestinal disease 3 (1.9) 1 (0.6) 0.23
Skin condition 12 (7.6) 8 (4.3) 0.28
Malignancy (hematologic or solid organ) 10 (6.3) 2 (1.2) <0.01
Transplant (hematopoietic stem cell or solid organ) 15 (9.5) 1 (0.6) <0.01
None 59 (37.3) 110 (65.1) <0.01
Any condition
99 (62.7)
59 (34.9)
<0.01
Epidemiologic classification of incident cases
Hospital onset 40 (25.3) 13 (7.7) <0.01
Community-associated 43 (27.2) 109 (64.5) <0.01
Healthcare-associated community onset 68 (43.0) 40 (23.7) <0.01
Unknown 7 (4.4) 7 (4.1) 0.90

*Values are no. (%) except as indicated. Fisher exact test used for comparative statistics when >20% of expected cell counts were <5. Boldface indicates p<0.05. CRE, carbapenem-resistant Enterobacterales; ESBL-E, extended-spectrum β-lactamase–producing Enterobacterales. †ESBL-E surveillance was completed for 6 months during 2019. ‡Clinical characteristics were available for cases with completed case report forms only. §Cases could have >1 underlying condition associated with culture. Underlying conditions are further defined as follows: premature birth, birth before the week 37 of pregnancy, selected if medical record indicated premature birth and patient was <2 y of age; diabetes mellitus, includes both type I and type II; neurologic condition, any, includes cerebral palsy, chronic cognitive deficits, epilepsy/seizure/seizure disorders, multiple sclerosis, neuropathy, and others; urinary tract problems/abnormalities, a structural or functional urinary tract abnormality leading to obstruction or retention of urine as documented in the medical record; cardiovascular disease, includes congenital heart disease, congestive heart failure, prior cerebrovascular accident/stroke, peripheral vascular disease; chronic pulmonary disease, includes cystic fibrosis and any chronic respiratory condition resulting in chronic symptomatic dyspnea in medical record; chronic renal disease, includes chronic kidney disease (all stages), end-stage renal disease with or without dialysis; gastrointestinal disease, includes inflammatory bowel disease, liver disease, peptic ulcer disease, and short gut syndrome; skin condition, includes pressure ulcers, surgical wounds, other skin conditions such as eczema, psoriasis; malignancy, includes hematologic, metastatic and nonmetastatic solid organ; transplant, includes hematopoietic stem cell and solid organ.

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Page updated: May 22, 2024
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