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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 4

Isolate culture source, collection location, and infection types among incident pediatric CRE and ESBL-E cases, United States*

Category CRE, 2016–2020 ESBL-E, 2019–2020† p value
Culture source n = 159 n = 207
Urine‡ 131 (82.4) 196 (94.7) <0.01
Blood 20 (12.6) 8 (3.9) <0.01
Other normally sterile site
 8 (5.0)
 3 (1.5)
 0.05
Isolate collection location§ n = 158 n = 169
Acute care hospital 49 (31.0) 15 (8.9) <0.01
Outside acute care hospital 108 (68.4) 154 (91.1) <0.01
Emergency department 16/108 (14.8) 0 <0.01
Outpatient setting 92/108 (85.2) 154/154 (100.0) <0.01
Long-term care facility 0 0 NA
Long-term acute care facility 0 0 NA
Unknown
 1 (0.6)
 0
 0.48
Infection types¶
Lower urinary tract infection# 89 (56.3) 125 (74.0) <0.01
Pyelonephritis 9 (5.7) 9 (5.3) 0.88
Bacteremia** 20 (12.7) 9 (5.3) 0.02
Other infection types 27 (17.1) 14 (8.3) 0.02
None 21 (13.3) 19 (11.2) 0.57
Unknown
 9 (5.7)
 8 (4.7)
 0.70
Healthcare exposures in prior year
Acute care hospitalization 74 (46.8) 38 (22.5) <0.01
Resident of long-term care facility 0 2 (1.2) 0.27
Admission to long-term acute care hospital 0 0 NA
Inpatient or outpatient surgery†† 61 (38.6) 16 (9.5) <0.01
Chronic dialysis 5 (3.2) 0 0.03
Indwelling device in the 2 d before DISC
Urinary catheter 29 (18.4) 20 (11.8) 0.10
Central venous catheter 37 (23.4) 12 (7.1) <0.01
Any other device 60 (38.0) 19 (11.2) <0.01
IV or oral antimicrobial use 30 d before DISC‡‡ N/A 52 (30.8) N/A
None of the above healthcare exposures
 43 (27.2)
 110 (65.1)
 <0.01
Outcomes, no. patients
Hospitalization among community-onset cases§§ 40/111 (36.0) 13/149 (8.7) <0.01
ICU admission ≤6 d after DISC
 10 (6.3)
 5 (3.0)
 0.15
30-d mortality
Cases with an incident blood or sterile site specimen 4/27 (14.8) 2/9 (22.2) 0.29
Cases with an incident urine specimen 2/131 (1.5) 0 0.23

*Values are no. (%) except as indicated. Denominators are indicated when different from total number. Fisher exact test used for comparative statistics when >20% of expected cell counts were <5. Boldface indicates p<0.05. CRE, carbapenem-resistant Enterobacterales; DISC, date of incident specimen collection; ESBL-E, extended-spectrum β-lactamase–producing Enterobacterales; IV, intravenous. †ESBL-E surveillance was completed for 6 mo during 2019. ‡Two incident urine CRE cases with subsequent nonincident blood cultures were identified. One incident urine ESBL-E case with subsequent nonincident blood culture was identified. Nonincident blood cultures are not counted here. §Isolate collection location, epidemiologic class, infection types available for cases with completed case report forms only. ¶Cases could have >1 type of associated infection reported. #Lower urinary tract infection includes cases involving infection of the bladder or urethra. Pyelonephritis, or infections involving the kidney(s), were counted separately. **Bacteremia includes cases with a positive blood specimen or a documented diagnosis of sepsis, septicemia, bacteremia, or blood stream infection. 3 CRE cases of sepsis and 2 ESBL-E cases of sepsis (with or without blood cultures) are included in the bacteremia classification above. ††Surgery defined as procedures occurring in an operating room where a surgeon makes >1 incision through skin or mucous membrane, including laparoscopic approach. Ambulatory surgery centers may be included. ‡‡Antimicrobial use (intravenous or oral) in 30 d before DISC collected for ESBL-E cases only. §§Hospitalization at time of or within 30 d after DISC.

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Page created: April 24, 2024
Page updated: May 22, 2024
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