Risk Factors for Infections Caused by Extended-spectrum Beta-Lactamase Producing and Carbapenem-resistant Enterobacterales in Pediatric Critical Care Settings: A Case-control Study.

Background: Infections due to Gram-negative resistant bacterial pathogens are a major concern in intensive care units (ICUs). Risk factors for extended-spectrum beta-lactamase (ESBL)-producing enterobacterales (ESBL-PE) and carbapenem-resistant enterobacterales (CRE) infections in pediatric critical care settings remain unclear.

Methods: This was a retrospective case-control study of infections due to ESBL-PE and CRE during a 5-year period (2016-2021). Control cases were matched for age, infection site and year of infection, but their cultures grew enterobacterales that were non-ESBL or carbapenemase producers.

Results: A total of 57 patients with ESBL-PE or CRE infections (cases) and 59 control patients were included. The majority of organisms were Escherichia coli and Klebsiella species recovered from the respiratory tract. There was no difference in prior hospital admission, pediatric ICU, or neonatal ICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (P > 0.3). Risk factors evaluated by univariate analysis included the history of antibiotic use in the last 6 months, antibiotic treatment with cephalosporins including cefepime, cephalosporins treatment duration ≥7 days, treatment with trimethoprim/sulfamethoxazole and carbapenems and vancomycin use ≥ 7 days. However, multivariate logistic regression analysis showed that cefepime use ≥ 7 days was the single best predictor for cases with an odds ratio of 2.205-fold (95% confidence interval, 1.403-3.466; P < 0.001).

Conclusions: Cefepime use ≥ 7 days was the most predictive risk factor of ESBL-PE and CRE acquisition. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens.