Rise of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli in children

J Microbiol Immunol Infect. 2014 Oct;47(5):399-405. doi: 10.1016/j.jmii.2013.05.006. Epub 2013 Jul 6.

Abstract

Background: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. Few studies are available regarding community-onset UTIs caused by extended-spectrum β-lactamase (ESBL)-producing bacteria in children.

Materials and methods: During a 5-year period, hospitalized children with community-onset UTI caused by ESBL-producing Escherichia coli (case) and those with non-ESBL-producing E. coli (control) were identified. Patients with long-term care facility stay within the preceding month and those with urine cultures obtained >72 hours after admission were excluded. Clinical features and risk factors associated with the occurrence of ESBL-producing E. coli UTI were reviewed.

Results: The prevalence of UTI due to ESBL-producing E. coli increased slightly from 0.59% in 2002 to 0.96% in 2006. A total of 104 cases and 208 controls were included for comparison. The ciprofloxacin resistance of the ESBL-producing E. coli increased significantly in this period (p = 0.006). Pre-existing neurological diseases (p < 0.001), use of antibiotics in the past 3 months (p < 0.001), and recent hospitalization within 1 month (p < 0.001) were found to be potential risk factors. Moreover, previous exposure to third-generation cephalosporins (p < 0.001) and aminoglycosides (p < 0.001) was associated with the selection of ESBL-producing E. coli. Children with ESBL-producing E. coli UTIs had a longer hospital stay (p = 0.031) than those without.

Conclusions: ESBL-producing E. coli gradually became coresistant to other broad-spectrum antibiotics, notably ciprofloxacin. UTIs caused by such resistant organisms led to a longer hospital stay and more antibiotic use. Reinforcement of infection control measures, especially hand washing in childcare settings and antibiotic stewardship, is critical to reduce the spread of ESBL-producing E. coli.

Keywords: Children; E. coli; Extended-spectrum β-lactamase; Urinary tract infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / pharmacology
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology
  • Community-Acquired Infections / pathology
  • Drug Resistance, Multiple, Bacterial
  • Escherichia coli / enzymology*
  • Escherichia coli / isolation & purification
  • Escherichia coli Infections / epidemiology*
  • Escherichia coli Infections / microbiology
  • Escherichia coli Infections / pathology
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay
  • Male
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Urinary Tract Infections / epidemiology*
  • Urinary Tract Infections / microbiology
  • Urinary Tract Infections / pathology
  • beta-Lactamases / metabolism*

Substances

  • Anti-Bacterial Agents
  • beta-Lactamases