111. A Growing Threat: The Rising Incidence of Extended-Spectrum Beta-Lactamase-Producing Enterobacterales Infections Among Pediatric Patients in Monroe County, NY

TL;DR

This study shows a significant rise in ESBL-E infections among children in Monroe County, NY, with infants being most affected and more likely to have risk factors like hospitalization or surgery.

Contribution

The study provides new insights into the epidemiology of ESBL-E infections in U.S. pediatric populations, particularly highlighting trends and risk factors specific to infants.

Findings

ESBL-E incidence increased from 26.1 to 36.9 per 100,000 population between 2019 and 2024 in Monroe County.

Infants had a 68.1% increase in ESBL-E incidence and were more likely to have risk factors like prematurity and hospitalization.

Most cases were community-associated, but infants were less likely to be classified as such compared to older children.

Abstract

Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) infections are increasing globally. Studies specific to the pediatric population in the U.S. are limited. This study aims to describe the epidemiology of ESBL-E infections in infants and children in Monroe County, NY.Table 1:Demographic and clinical characteristics of pediatric patients with ESBL-E infections, Monroe County, July 2019-2024Figure 1:ESBL-E Incidence by age group, Monroe County, 2019-2024

Demographic and clinical characteristics of pediatric patients with ESBL-E infections, Monroe County, July 2019-2024

ESBL-E Incidence by age group, Monroe County, 2019-2024

ESBL-E infections in residents < 18 years were identified from 7/2019 to 12/2024 through CDC Emerging Infections Program surveillance. Incident cases were defined by the first isolation of E. coli or Klebsiella spp. from sterile sites or urine within 30-day period, resistant to ≥1 3rd-generation cephalosporin but not carbapenems. Demographic and clinical data were collected for incident cases but limited to the first per year for a urine source. Cases were categorized as infants (< 2 yrs) or children (2-17 yrs). Epidemiologic classification was based on healthcare exposure; cases without such exposure were defined as community-associated (CA). Descriptive analyses were conducted using Chi-square or Fisher exact tests.

From July 2019-2024, we identified 247 ESBL-E cases [TB1] in 189 children. ESBL-E incidence increased from 26.1/ 100,000 population in 2019 to 36.9 in 2024. The incidence in infants rose by 68.1% over this period (Figure 1). Of the 211 cases with complete medical record review, the majority (73.5%) were CA. The epidemiologic classification varied by age group, with only 41.7% of the cases in infants classified as CA. Infants were more likely to have been born prematurely (30.6% vs. 0.7%), had a central venous catheter in place around the time of culture (8.3% vs. 1.1%), and had a hospitalization (41.7% vs. 12.6%) or surgery (19.4% vs. 4%) in the year preceding their infection. Antimicrobial use in the prior month was documented in 41.7% of infants and 28% of children. Underlying conditions were more commonly documented in infants (52.8%) than in children (38.9%). Among all pediatric patients, recurrent UTIs and urinary tract abnormalities were the most frequently observed conditions. (Table 1).

ESBL-E incidence is rising in the pediatric population, with infants experiencing the most significant increase. Understanding age-related differences in epidemiology and risk factors is necessary to guide prevention efforts.

All Authors: No reported disclosures

Figures