Risk factors for and clinical outcomes of infections caused by extended-spectrum-β-lactamase-producing escherichia coli in children: Results of a 5 year study

Abstract

Aim: The prevalence of extended-spectrum beta lactamase (ESBL) producing bacterial pathogens, particulary in intensive care units, has been increasing worldwide. The aim of this study was to define the risk factors and clinical outcomes associated with ESBL-producing Escherichia coli (E. coli) infections in children.Material and Method: We conducted a case-control study between January 1, 2004 and December 31, 2008 at the Uludag University Pediatric Clinic. All patients with ESBL-producing E. coli infections were compared to patients with non-ESBL-producing E. coli infections. Risk factors analyzed included prior antibiotic use, underlying diseases, invasive medical devices, and other demographic characteristics.Results: E. coli infections were diagnosed in 136 of the 8879 patients hospitalized in our center between January 1, 2004 and December 31, 2008 (overall incidence, 15.3 per 1,000 admissions). The mean age of patients was 55.4+/-52.6 months (3 days-18 years) and 60% were female. The prevalence of ESBL-producing isolates among E. coli was found to be 54.4%. Sixtyeight percent of the E. coli infections were nosocomial. In this study, risk factors for ESBL-producing E. coli infections included pediatric intensive care unit stay, nosocomial infection, therapy with broad-spectrum antibiotics, prolonged exposure to broad-spectrum antibiotics, prolonged hospitalization, use of immunosuppressant medications, blood transfusion, presence of a central venous catheter and total parenteral nutrition (p< 0.05). The mortality rate of E. coli infection was found to be 16.9%. Predisposing factors associated with mortality were; presence of septic shock, congenital heart disease, nosocomial infection, presence of ESBL-producing E. coli infections, pediatric intensive care unit stay, therapy with broad-spectrum antibiotics, prolonged exposure to broad-spectrum antibiotics, prolonged hospitalization, neutropenia, presence of central venous catheter and mechanical ventilation (p<0.05).Conclusion: In this study, the prevalence of ESBLproducing isolates among E. coli was 54.4%. The mortality (24.3%) for the patients in the ESBL group was significantly higher than the mortality for the patients in the non-ESBL group (8%) (p<0.05).