PMID- 30169484 OWN - NLM STAT- MEDLINE DCOM- 20200402 LR - 20200501 IS - 1532-0987 (Electronic) IS - 0891-3668 (Print) IS - 0891-3668 (Linking) VI - 38 IP - 5 DP - 2019 May TI - A Multi-Centered Case-Case-Control Study of Factors Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Infections in Children and Young Adults. PG - 490-495 LID - 10.1097/INF.0000000000002176 [doi] AB - BACKGROUND: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae (KPC-CRE) are multidrug-resistant organisms causing morbidity and mortality worldwide. KPC-CRE prevalence is increasing in pediatric populations, though multi-centered data are lacking. Identifying risk factors for KPC-CRE infection in children and classifying genotypes is a priority in this vulnerable population. METHODS: A case-case-control study of patients (0-22 years) at 3 tertiary-care Chicago-area medical centers, 2008-2015, was conducted. Case group 1 children possessed KPC-CRE infections; case group 2 harbored carbapenem-susceptible Enterobacteriaceae (CSE) infections; controls had negative cultures. Case-control matching was 1:1:3 by age, infection site and hospital. Statistical and molecular analyses were performed. RESULTS: Eighteen KPC-CRE infections were identified; median patient age was 16.5 years. Of 4 available KPC-CRE, 2 were unrelated, non-ST258 KP strains harboring blaKPC-2, one was a ST258 KP harboring blaKPC-3, and the last was an E. coli containing blaKPC-2. KPC-CRE and CSE-infected patients had more multidrug-resistant organisms infections, long-term care facility admissions and lengths of stay (LOS) > 7 days before culture. KPC-CRE and CSE patients had more gastrointestinal comorbidities (odds ratios [Ors], 28.0 and 6.4) and >/= 3 comorbidities (Or 15.4 and 3.5) compared with controls; KPC-CRE patients had significantly more pulmonary and neurologic comorbidities (both ORs 4.4) or GI and pulmonary devices (ORs, 11.4 and 6.1). Compared with controls, CSE patients had more prior fluoroquinolone use (OR, 7.4); KPC-CRE patients had more carbapenem or aminoglycoside use (ORs, 10.0 and 8.0). Race, gender, LOS and mortality differences were insignificant. CONCLUSIONS: Pediatric patients with KPC-CRE infection suffer from high multi-system disease/device burdens and exposures to carbapenems and aminoglycosides. Different from adult reports, non-ST258 KP strains were more common, and LOS and mortality rates were similar in all groups. Pediatric CRE control in should focus on modifiable risk factors including antibiotic and device utilization. FAU - Logan, Latania K AU - Logan LK AD - From the Department of Pediatrics. AD - Section of Pediatric Infectious Diseases, Rush University Medical Center, Rush Medical College, Chicago, IL. AD - Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH. AD - Department of Pediatrics, Cook County Health and Hospitals System, Chicago, IL. FAU - Nguyen, David C AU - Nguyen DC AD - From the Department of Pediatrics. AD - Department of Medicine, Rush University Medical Center, Rush Medical College, Chicago, IL. AD - Department of Pediatrics, Division of Infectious Diseases. AD - Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH. FAU - Scaggs Huang, Felicia A AU - Scaggs Huang FA AD - From the Department of Pediatrics. AD - Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. FAU - Qureshi, Nadia K AU - Qureshi NK AD - Department of Pediatrics, Section of Pediatric Infectious Diseases, Loyola University Medical Center, Maywood, IL. FAU - Charnot-Katsikas, Angella AU - Charnot-Katsikas A AD - Department of Pathology, The University of Chicago Medicine, Chicago, IL. FAU - Bartlett, Allison H AU - Bartlett AH AD - Department of Pediatrics, Division of Pediatric Infectious Diseases, The University of Chicago Medicine, Chicago, IL. FAU - Zheng, Xiaotian AU - Zheng X AD - Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. FAU - Hujer, Andrea M AU - Hujer AM AD - Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH. FAU - Domitrovic, T Nicholas AU - Domitrovic TN AD - Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH. FAU - Marshall, Steven H AU - Marshall SH AD - Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH. FAU - Bonomo, Robert A AU - Bonomo RA AD - Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH. AD - Department of Medicine, Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western University, Cleveland, OH. FAU - Weinstein, Robert A AU - Weinstein RA AD - Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Rush Medical College, Chicago, IL. AD - Department of Medicine, Cook County Health and Hospital Systems, Chicago, IL. LA - eng GR - R01 AI100560/AI/NIAID NIH HHS/United States GR - R01 AI072219/AI/NIAID NIH HHS/United States GR - R01 AI063517/AI/NIAID NIH HHS/United States GR - K08 AI112506/AI/NIAID NIH HHS/United States GR - I01 BX001974/BX/BLRD VA/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Pediatr Infect Dis J JT - The Pediatric infectious disease journal JID - 8701858 SB - IM MH - Adolescent MH - Carbapenem-Resistant Enterobacteriaceae/classification/genetics/*isolation & purification MH - Case-Control Studies MH - Chicago/epidemiology MH - Child MH - Child, Preschool MH - Female MH - *Genotype MH - Humans MH - Infant MH - Infant, Newborn MH - Klebsiella Infections/*epidemiology MH - Klebsiella pneumoniae/classification/genetics/*isolation & purification MH - Male MH - Molecular Typing MH - Prevalence MH - Risk Factors MH - Tertiary Care Centers MH - Young Adult PMC - PMC6395555 MID - NIHMS1504027 COIS- Conflicts of Interest: The authors have no conflicts of interest relevant to this article. EDAT- 2018/09/01 06:00 MHDA- 2020/04/03 06:00 PMCR- 2020/05/01 CRDT- 2018/09/01 06:00 PHST- 2018/09/01 06:00 [pubmed] PHST- 2020/04/03 06:00 [medline] PHST- 2018/09/01 06:00 [entrez] PHST- 2020/05/01 00:00 [pmc-release] AID - 10.1097/INF.0000000000002176 [doi] PST - ppublish SO - Pediatr Infect Dis J. 2019 May;38(5):490-495. doi: 10.1097/INF.0000000000002176.