Escherichia coli bacteraemia in children: age and portal of entry are the main predictors of severity

Résumé : Background: Escherichia coli bacteraemia is a major cause of severe sepsis in children. Little is known about predictors of severity. Methods: We analysed 84 children ≤18-year-old with E. coli bacteraemia from the prospective COLIBAFI study performed in 2005-2007. Bacteraemia’s severity was defined as occurrence of death or transfer to intensive care unit. Studied characteristics included age, gender, birth weight, history of prematurity, immunodepression, nosocomial infection, portal of entry, phylogenetic group and subgroup belonging, O-type, virulence gene content and antimicrobial susceptibility. We compared bacterial characteristics in urinary- vs. digestive-source bacteraemia, in children ≤3 vs. >3-month-old, and in children vs. adults. We also searched for risk factors of severity. Results: Median age was 2.4 months, 57% males. Most frequent portals of entry were urinary and digestive tracts. Most isolates belonged to B2 phylogroup. Strains in children ≤3-month-old exhibited more virulence genes, especially neuC and fyuA/irp2, and were less resistant to antibiotics than in children >3-month-old. Comparing community-acquired urinary-source bacteraemia between children and adults, we found that bacteraemia were less severe in children, whose strains exhibited a specific virulence gene repertoire and had a higher resistance score than in adults. Seventeen children (20.2%) had a severe bacteraemia and 8 died. Non-urinary portal of entry and age ≤3-month-old were the only risk factors associated with severity. Conclusions: E. coli strains responsible for bacteraemia exhibit specific characteristics according to age of children. However, host characteristics and portal of entry are the main determinants of severity of E. coli bacteraemia in children, as observed in adults.
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Soumis le : dimanche 9 novembre 2014 - 19:59:52
Dernière modification le : mardi 23 janvier 2018 - 11:56:14
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Charles Burdet, Olivier Clermont, Stéphane Bonacorsi, Cédric Laouénan, Edouard Bingen, et al.. Escherichia coli bacteraemia in children: age and portal of entry are the main predictors of severity. Pediatric Infectious Disease Journal, Lippincott, Williams & Wilkins, 2014, 33 (2), pp.872. 〈10.1097/INF.0000000000000309〉. 〈inserm-01079025〉

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