Prevalence of ESBL-Producing Enterobacteriaceae in Pediatric Bloodstream Infections: A Systematic Review and Meta-Analysis

Myrto Eleni Flokas,Michail Alevizakos,Styliani Karanika,Eleftherios Mylonakis,Umberto Simeoni

doi:10.1371/journal.pone.0171216

Myrto Eleni Flokas, Michail Alevizakos + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0171216

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Journal: PloS one	Publication Date: Jan 31, 2017
Citations: 67	License type: CC BY 4.0

Affiliation: Brown University, Rhode Island Hospital

Abstract

BackgroundPediatric bloodstream infections (BSIs) with Extended-Spectrum Beta-Lactamase- producing Enterobacteriaceae (ESBL-PE) are associated with worse clinical outcomes. We aimed to estimate the prevalence of and the mortality associated with ESBL-PE in this patient population.MethodsA systematic review and meta-analysis using PubMed and EMBASE and included studies reporting the prevalence of ESBL-PE among confirmed BSIs in patients <19 years old.ResultsTwenty three (out of 1,718 non-duplicate reports) studies that provided data on 3,381 pediatric BSIs from 1996 to 2013 were included. The prevalence of ESBL-PE was 9% [95%CI (6, 13)] with an annual increase of 3.2% (P = 0.04). The prevalence was 11% [95%CI (6, 17)] among neonates, compared to 5% [95%CI (0, 14)] among children older than 28 days. The pooled prevalence was 15% in Africa [95%CI (8, 23)], 12% in South America [95%CI (5, 23)], 11% in India [95%CI (7, 17)], 7% in the rest of Asia [95%CI (0, 22)], 4% in Europe [95%CI (1, 7)] and 0% in Oceania [95%CI (0, 3)]. Importantly, the mortality in neonates with BSI due to ESBL-PE was 36% [95%CI (22, 51)], compared to 18% [95%CI (15, 22)] among all other neonates with BSI and this difference was statistically significant (P = 0.01).ConclusionsIn the pediatric population, the prevalence of BSI due to ESBL-PE is significant and is associated with increased mortality in neonates. Further studies are warranted to establish a high-risk group and the evaluation of preventive measures, such as antibiotic stewardship programs and infection control measures, in this population is urgently needed.

Highlights

Extended-spectrum beta-lactamases (ESBL) are enzymes produced by Enterobacteriaceae that hydrolyze most beta-lactams [1] They are frequently encoded by plasmids that carry genes conveying resistance to other antibiotic groups, such as aminoglycosides and fluoroquinolones [1]
The prevalence of Extended-Spectrum Beta-Lactamase- producing Enterobacteriaceae (ESBL-PE) was 9% [95%confidence intervals (CI) (6, 13)] with an annual increase of 3.2% (P = 0.04)
Given the clinical significance of these infections, we aimed to evaluate the burden of ESBL-PE among pediatric bloodstream infections (BSIs)

Summary

Introduction

Extended-spectrum beta-lactamases (ESBL) are enzymes produced by Enterobacteriaceae that hydrolyze most beta-lactams [1] They are frequently encoded by plasmids that carry genes conveying resistance to other antibiotic groups, such as aminoglycosides and fluoroquinolones [1]. Bloodstream infections (BSIs) with ESBL-producing Enterobacteriaceae (ESBL-PE) are associated with longer hospital stays, increased healthcare costs and worse outcomes [4,5,6,7]. Given the clinical significance of these infections, we aimed to evaluate the burden of ESBL-PE among pediatric BSIs. the purpose of this systematic review and meta-analysis is to estimate the prevalence and geographical distribution of BSI attributed to ESBL-PE among pediatric patients in non-outbreak settings. Pediatric bloodstream infections (BSIs) with Extended-Spectrum Beta-Lactamase- producing Enterobacteriaceae (ESBL-PE) are associated with worse clinical outcomes. We aimed to estimate the prevalence of and the mortality associated with ESBL-PE in this patient population

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