Community origins and regional differences in plasmid-mediated fluoroquinolone resistant Enterobacteriaceae infections in children

Logan, L. K.; Medernach, R. L.; Rispens, J. R.; Marshall, S. H.; Hujer, A. M.; Domitrovic, T. N.; Rudin, S. D.; Zheng, X.; Qureshi, N. K.; Konda, S.; Hayden, M.; Weinstein, R. A.; Bonomo, R. A.

doi:10.1101/301457

bioRxiv · 10.1101/301457

Community origins and regional differences in plasmid-mediated fluoroquinolone resistant Enterobacteriaceae infections in children

Logan, L. K.·Medernach, R. L.·Rispens, J. R.·Marshall, S. H.·Hujer, A. M.·Domitrovic, T. N.·Rudin, S. D.·Zheng, X.·Qureshi, N. K.·Konda, S.·Hayden, M.·Weinstein, R. A.·Bonomo, R. A.

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Abstract

BackgroundFluoroquinolones (FQs) are uncommonly prescribed in children, yet pediatric multidrug-resistant (MDR)-Enterobacteriaceae (Ent) infections often reveal FQ resistance (FQR). We sought to define the molecular epidemiology of FQR and MDR-Ent in children.\n\nMethodsA case-control analysis of children with MDR-Ent infections at 3 Chicago hospitals was performed. Cases were children with third-generation-cephalosporin-resistant (3GCR) and/or carbapenem-resistant (CR)-Ent infections. PCR and DNA analysis assessed bla and plasmid-mediated FQR (PMFQR) genes. Controls were children with 3GC and carbapenem susceptible-Ent infections matched by age, source and hospital. We assessed clinical-epidemiologic predictors of PMFQR Ent infection.\n\nResultsOf 169 3GCR and/or CR Ent isolates from children (median age 4.8 years), 85 were FQR; 56 (66%) contained PMFQR genes. The predominant organism was E. coli and most common bla gene bla CTX-M-1 group. In FQR isolates, PMFQR gene mutations included aac61b-cr, oqxA/B, qepA, and qnrA/B/D/S in 83%, 15%, 13% and 11% of isolates, respectively. FQR E. coli was often associated with phylogroup B2, ST43/ST131. On multivariable analysis, PMFQR Ent infections occurred mostly in outpatients (OR 33.1) of non-black-white-Hispanic race (OR 6.5). Residents of Southwest Chicago were >5 times more likely to have PMFQR-Ent infections than those in the reference region, while residence in Central Chicago was associated with a 97% decreased risk. Other demographic, comorbidity, invasive-device, antibiotic use, or healthcare differences were not found.\n\nConclusionsThe strong association of infection with MDROs showing FQR with patient residence rather than with traditional risk factors suggests that the community environment is a major contributor to spread of these pathogens in children.

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Logan, L. K., Medernach, R. L., Rispens, J. R., Marshall, S. H., Hujer, A. M., Domitrovic, T. N., Rudin, S. D., Zheng, X., Qureshi, N. K., Konda, S., Hayden, M., Weinstein, R. A., Bonomo, R. A.. 2018-04-16. Community origins and regional differences in plasmid-mediated fluoroquinolone resistant Enterobacteriaceae infections in children. https://doi.org/10.1101/301457

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