Study: ESBL-E infections more common than CRE in US children
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Key takeaways:
- CRE cases were less frequent but were associated with hospitalization.
- Over half of CRE cases were caused by E. cloacae complex, and more than 85% of ESBL-E cases were caused by E. coli.
Cases of carbapenem-resistant Enterobacterales, or CRE, were not as common in U.S. children as cases of extended-spectrum beta-lactamase-producing Enterobacterales, or ESBL-E, according to a study published in Emerging Infectious Diseases.
However, CRE was associated with more severe outcomes in children, researchers said.
CRE and ESBLE-E are a public health concern because of “limited treatment options and the potential for spread within communities and health care facilities,” one of the study’s authors told Healio.
“While CRE and ESBL-E have been extensively studied in adults, few studies have described the epidemiology of these bacteria in children,” Alice Y. Guh, MD, MPH, a medical officer in the Division of Healthcare Quality Promotion at the CDC, said in an interview. “Therefore, to better characterize the U.S. epidemiology of pediatric CRE and ESBL-E, we sought to determine how frequently CRE and ESBL-E infections occurred in children across geographically diverse locations and to describe their associated clinical characteristics.”
Guh and colleagues analyzed data collected by the CDC’s Emerging Infections Program, which conducts laboratory- and population-based surveillance for CRE and ESBL-E in selected counties across several U.S. states. Specifically, the researchers focused on CRE surveillance data from 10 sites between 2016 and 2020, and ESBL-E surveillance data from six sites between 2019 and 2020.
Researchers found that among 159 CRE cases in 142 children (median age of 5 years), CRE was isolated from urine in 82.4% of the cases and from blood in 12.6% of the cases, with an overall annual CRE incidence rate of 0.7 per 100,000 population during the 5-year period. The rate ranged between 0.47 and 0.87 cases per 100,000 population. In most cases, the isolate was Enterobacter cloacae complex, responsible for 52.2% of the infections, followed by Escherichia coli, (31.5%), Klebsiella pneumoniae (10.7%), Klebsiella aerogenes (3.1%) and Klebsiella oxytoca (2.5%).
In 207 ESBL-E cases in 184 children (median age of 6 years), ESBL-E was isolated from urine in 94.7% of cases and from blood in 3.9% of cases, with an overall annual ESBL-E incidence rate of 23.08 per 100,000 population. The rate ranged from 26.5 cases per 100,000 in 2019 and 19.63 cases per 100,000 in 2020. The predominant isolate was E. coli, comprising 87.9% of those cases, followed by K. pneumoniae (11.1%) and K. oxytoca (1%).
Additionally, 43% of the CRE infections and 23.7% of the ESBL-E infections were health care-associated community-onset cases, and 27.2% of the CRE infections and 64.5% of the ESBL-E infections were community-associated cases.
“We know that CRE are less common than ESBL-E in the U.S.,” Guh said. “Therefore, we were not surprised to find that CRE infections occurred less frequently than ESBL-E infections in U.S. children, although they were more often associated with health care risk factors and hospitalization than ESBL-E infections.”
However, the researchers were surprised by the finding that infants consistently had higher rates of infections with each of these pathogens than children in other age groups — ranging from 1.95 to 3.82 cases per 100,000 for CRE and 46.85 to 91.97 cases per 100,000 for ESBL-E — Guh said.
She added that the study findings indicate the importance of continuing surveillance for CRE and ESBL-E in children.
“CRE and ESBL-E are important public health threats in children,” Guh said. “Continued infection prevention and control practices and antimicrobial stewardship in pediatric health care settings are needed. As more years of data become available, updates on the epidemiology of these bacteria in children may be warranted.”
References:
Grome HN, et al. Emerg Infect Dis. 2024;doi:10.3201/eid3006.231734.
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