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Prevalence and Risk Factors of Fecal Carriage of Extended-Spectrum β-lactamase (ESBL) -Producing Enterobacteriaceae in Hospitalized and Ambulatory Children

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Author(s): Abdurrahman Kiremitci | Ener Cagri Dinleyici | Zeynel Abidin Yargic | Gul Durmaz | Neslihan Tekin | Askin Derya Aybey | Mehmet Arif Aksit

Journal: Cocuk Enfeksiyon Dergisi
ISSN 1307-1068

Volume: 5;
Issue: 02;
Start page: 54;
Date: 2011;
Original page

Keywords: Extended-spectrum beta lactamase | ESBL | children | fecal carriage | E. coli

ABSTRACT
Objective: The isolation of extended-spectrum β-lactamase (ESBL) -producing bacteria has increased worldwide. Fecal colonization with ESBL-producing isolates is considered a prerequisite for infection.Material and Methods: We prospectively evaluated the prevalence and risk factors for fecal carriage of ESBL-producing E. coli and Klebsiella spp. in hospitalized and ambulatory children. A total of 464 fecal samples from pediatric patients (270 hospitalized and 194 ambulatory) were collected from a tertiary care center in Turkey during a non-outbreak period. All stool samples were evaluated for ESBL production by the combination disc test and for imipenem susceptibility by the CLSI agar dilution method.Results: Sixty-six (24% of total) hospitalized children (25 with Escherichia coli, 39 with Klebsiella pneumoniae and 2 with Klebsiella oxytoca) and 14 (7.2% of total) ambulatory children (10 with E. coli, 3 with K. pneumoniae and 1 with K. oxytoca) had a positive fecal sample for ESBL-producing microorganisms. All isolates were susceptible to imipenem; however, the MIC values of strains isolated from hospitalized patients were 3-4 fold higher in dilution than were those of strains isolated from ambulatory children. Univariate analyses showed that intensive care unit stay, urinary catheterization, indwelling catheterization, surgical interventions and prior 3rd-generation cephalosporin usage were associated with ESBL positivity for the hospitalized patients. Recent 2nd- or 3rd-generation cephalosporin use was found to be associated with ESBL positivity for the ambulatory children. Conclusion: The increased prevalence and antibiotic resistance of ESBL-producing fecal isolates in asymptomatic hospitalized and ambulatory children highlights the importance of these pathogens for the population.
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