# 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.

## Key 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