Risk Factors For and Outcomes of Multidrug-Resistant Escherichia coli Infections in Children

Abstract

IntroductionThe recent increase in multidrug-resistant (MDR) Escherichia coli infections is not well described in children. We determined the risk factors and outcomes of extraintestinal E. coli infections in children in our region.MethodsWe conducted a retrospective cohort study of children ≤18 years in Olmsted County, MN, USA, between January 1, 2012 and December 31, 2012. MDR isolates were defined as resistant to ≥3 antibiotic classes.ResultsA total of 368 children each contributed 1 isolate. Isolates were predominantly community-associated (82%) and from urine (90%), and outpatients (86%); 46 (13%) isolates were MDR. In multivariable analysis, genitourinary (GU) tract anomaly (OR 2.42, 95% CI 1.03–5.68), invasive devices (OR 3.48, 95% CI 1.37–8.83) and antibiotic use at presentation (OR 2.62, 95% CI 1.06–6.47) were associated with MDR E. coli. Children with MDR infections were more likely to have a complex infection (35% vs. 17%, P = 0.026), less likely to receive effective empiric antibiotics (47% vs. 74%, P < 0.001), had longer time to receipt of effective antibiotics (median 19.2 vs. 0.6 h, P < 0.001), and longer hospitalization (median 10 vs. 4 days, P = 0.029) than children with non-MDR infections.ConclusionPediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.

Evaluation of the health and healthcare system burden due to antimicrobial-resistant Escherichia coli infections in humans: a systematic review and meta-analysis

“…Results related to multidrug-resistant E. coli infections and all-cause mortality were reported in five studies and all five studies were included in the random effects meta-analysis (Additional file 11 c) [ 39 , 45 , 60 – 62 ]. Based on random effects meta-analysis of five studies, patients with multidrug-resistant E. coli infections had significantly higher odds of dying compared to patients with non-multidrug-resistant E. coli infections (sOR 1.63, 95% CI 1.55–1.70, p < 0.001; Additional file 14 ).…”

“…Two studies reported results for treatment failure and MDR (Additional file 17 c) [ 41 , 62 ]. Both of the studies reported clinical treatment failure.…”

Community-acquired urinary tract infections in children

“…for treating common paediatric infections like otitis media or pharyngitis). Other factors contributing to high antimicrobial resistance include challenges related to infection control practices and heavy international travel activities due to the large population of expatriates working in Saudi Arabia [15].…”

Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients

“…26 However, recent evidence obtained from evaluating isolates of pediatric patients primarily with E coli UTI infections in 2012 suggested rising rates (up to 13%) of multidrug-resistant E coli , resistant to TMP-SMX, ampicillin-sulbactam, and first-generation cephalosporins. 27 Additionally, even broader-spectrum oral cephalosporins have been associated with increased recurrence rates compared with ciprofloxacin in adult women, 28 attributed to their poorer bioavailability, resulting in inadequate tissue concentrations to eradicate the causative uropathogen from the vaginal flora. However, given the numerically lower recurrence rates observed for the oral cephalosporins alone, it is also possible that the patients who received intravenous therapy reflect a higher-risk population with a greater predisposition for UTI recurrence irrespective of drug selection (ie, confounding by indication).…”