Risk Factors Associated with ESBL and CPE Acquisition among Pediatrics: A Systematic Review

Aims Infections by extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) are increasing problems in pediatrics and are usually associated with higher hospital costs and mortality rates. The aims of this study were the statistical investigation of the worldwide prevalence and risk factors of ESBL and CPE family members among pediatric population. Instruments & Methods From October 1, 1995 to July 27, 2017, some keywords including “ESBLs”, “carbapenemase”, “pediatrics”, “children”, and “risk factor” were searched in the searching databases such as Google Scholar, Embase, Scopus, PubMed, and Web of Science among original research articles. The univariate and multivariate analysis of the collected data was performed by Graph Pad Prism 6.1 software. Findings The mean percentage of ESBL production was 20.23±22.31 and the mean percentage of CPE was 1.81±2.77. E. coli (n=991) and K. pneumonia (n=627) were the predominant ESBLproducers. Nephrology (n=5005) and NICU (n=1805) were predominant hospital wards. ESBLPE had significantly higher prevalence in the infants unit (OR=0.9832, 95% CI=12.271-19.519; p<0.001). Moreover, ICU ward was a significant and independent risk factor for CPE acquisition (OR=0.849, 95% CI=2.211-5.415; p=0.0035). ESBL-PE and CPE were significantly isolated from blood samples (OR=0.9276, 95% CI=1.508-2.433, p<0.0001) and fecal specimens (OR=0.968, 95% CI=2.829-5.133, p<0.0001), respectively. Conclusion Most of risk factors between ESBL-PE and CPE are similar including previous hospitalization and prolonged use of antibiotics, cephalosporins, and previous colonization. Other possible potential risk factors that should be considered include presence of catheters and travel history. Detection of risk factors provides useful information for formulation of infection control policy.