Abstract
The aim of this study was to investigate the annual incidence of Escherichia coli isolates in urinary tract infections (UTIs) and the antimicrobial resistance of the third-generation cephalosporin (3GCs) to E. coli, including the factors associated with the resistance in hospitalized children in Taiwan. A large electronic database of medical records combining hospital admission and microbiological data during 2004–2018 was used to study childhood UTIs in Taiwan. Annual incidence rate ratios (IRR) of E. coli in children with UTIs and its resistant rate to the 3GCs and other antibiotics were estimated by linear Poisson regression. Factors associated with E. coli resistance to 3GCs were assessed through multivariable logistic regression analysis. E. coli UTIs occurred in 10,756 unique individuals among 41,879 hospitalized children, with 92.58% being community associated based on urine culture results reported within four days after the hospitalization. The overall IRR E. coli UTI was 1.01 (95% confidence interval (CI) 0.99–1.02) in community-associated (CA) and 0.96 (0.90–1.02) in healthcare-associated infections. The trend in 3GCs against E. coli increased (IRR 1.18, 95% CI 1.13–1.24) over time in CA-UTIs. Complex chronic disease (adjusted odds ratio (aOR), 2.04; 95% CI, 1.47–2.83) and antibiotics therapy ≤ 3 months prior (aOR, 1.49; 95% CI, 1.15–1.94) were associated with increased risk of 3GCs resistance to E. coli. The study results suggested little or no change in the trend of E. coli UTIs in Taiwanese youths over the past 15 years. Nevertheless, the increase in 3GCs-resistant E. coli was substantial. Interventions for children with complex chronic comorbidities and prior antibiotic treatment could be effective in reducing the incidence of 3GCs-resistant E. coli in CA-UTIs in this region and more generally.
Highlights
Urinary tract infection (UTI) is one of the most common severe bacterial infections in children, and more than 10% of children subsequently develop long-term complications, such as renal scars [1].Escherichia coli of the Enterobacteriaceae family is the most common uropathogen in urinary tract infections (UTIs) [2,3], and the rise of antibiotic-resistant E. coli in pediatric UTI populations is a cause for concern in Taiwan [4,5] and around the whole world [6,7]
Details regarding the annual number of hospital admissions combining isolated E. coli uropathogen results >105 colony-forming units (CFU)/mL are presented in Supplementary Materials
Children < 1 year of age comprised approximately 80% of the incident E. coli community-associated UTIs (CA-UTIs) cohort, with the mean age at the index hospitalization being younger in community cases than those deemed healthcare-associated (1.22 (±2.6) vs. 2.42 (±4.57), respectively; p < 0.0001)
Summary
Escherichia coli of the Enterobacteriaceae family is the most common uropathogen in urinary tract infections (UTIs) [2,3], and the rise of antibiotic-resistant E. coli in pediatric UTI populations is a cause for concern in Taiwan [4,5] and around the whole world [6,7]. Recent data suggest that the prevalence of 3GCs-resistant E. coli isolates in CA-UTIs has increased over time in adult populations [12,13]. Prior studies have focused on antibiotic resistant E. coli in children with UTIs, most were derived from single centers or case-control studies designed in various geographic regions [11,14,15,16,17,18,19,20].
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