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

Nai Chia Fan, Hsin Hang Chen, Chyi Liang Chen, Liang Shiou Ou, Tzou Yien Lin, Ming Han Tsai, Cheng Hsun Chiu

Research output: Contribution to journalArticle

55 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)399-405
Number of pages7
JournalJournal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi
Volume47
Issue number5
DOIs
Publication statusPublished - Oct 1 2014
Externally publishedYes

Fingerprint

Urinary Tract Infections
Escherichia coli
Anti-Bacterial Agents
Ciprofloxacin
Length of Stay
Bacteria
Hand Disinfection
Preexisting Condition Coverage
Hospitalized Child
Aminoglycosides
Long-Term Care
Cephalosporins
Infection Control
Hospitalization
Urine

Keywords

  • Children
  • E. coli
  • Extended-spectrum β-lactamase
  • Urinary tract infection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Rise of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli in children. / Fan, Nai Chia; Chen, Hsin Hang; Chen, Chyi Liang; Ou, Liang Shiou; Lin, Tzou Yien; Tsai, Ming Han; Chiu, Cheng Hsun.

In: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi, Vol. 47, No. 5, 01.10.2014, p. 399-405.

Research output: Contribution to journalArticle

Fan, Nai Chia ; Chen, Hsin Hang ; Chen, Chyi Liang ; Ou, Liang Shiou ; Lin, Tzou Yien ; Tsai, Ming Han ; Chiu, Cheng Hsun. / Rise of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli in children. In: Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2014 ; Vol. 47, No. 5. pp. 399-405.
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AU - Ou, Liang Shiou

AU - Lin, Tzou Yien

AU - Tsai, Ming Han

AU - Chiu, Cheng Hsun

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N2 - 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.

AB - 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.

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KW - Urinary tract infection

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