Abstract
Introduction: The 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. Methods: We 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. Results: A 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. Conclusion: Pediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 245-257 |
| Number of pages | 13 |
| Journal | Infectious Diseases and Therapy |
| Volume | 6 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jun 1 2017 |
| Externally published | Yes |
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Keywords
- Antimicrobial resistance
- E. coli
- Multidrug-resistant E. coli
ASJC Scopus subject areas
- Infectious Diseases
- Microbiology (medical)
Cite this
Risk Factors For and Outcomes of Multidrug-Resistant Escherichia coli Infections in Children. / Uzodi, Adaora S.; Lohse, Christine M.; Banerjee, Ritu.
In: Infectious Diseases and Therapy, Vol. 6, No. 2, 01.06.2017, p. 245-257.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Risk Factors For and Outcomes of Multidrug-Resistant Escherichia coli Infections in Children
AU - Uzodi, Adaora S.
AU - Lohse, Christine M.
AU - Banerjee, Ritu
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Introduction: The 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. Methods: We 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. Results: A 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. Conclusion: Pediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.
AB - Introduction: The 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. Methods: We 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. Results: A 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. Conclusion: Pediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.
KW - Antimicrobial resistance
KW - E. coli
KW - Multidrug-resistant E. coli
UR - http://www.scopus.com/inward/record.url?scp=85020052851&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020052851&partnerID=8YFLogxK
U2 - 10.1007/s40121-017-0152-3
DO - 10.1007/s40121-017-0152-3
M3 - Article
VL - 6
SP - 245
EP - 257
JO - Infectious Diseases and Therapy
JF - Infectious Diseases and Therapy
SN - 2193-8229
IS - 2
ER -