Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study.
<h4>Background</h4> <p>All-cause antibiotic prescribing affects bowel flora antimicrobial susceptibility, and may increase risk of urinary autoinoculation with antibiotic-resistant microbes. However, little is known about relative prevalence of, or risk factors for, antimicrobial...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
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Oxford University Press
2018
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| _version_ | 1797080100298031104 |
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| author | Bryce, A Costelloe, C Wootton, M Butler, C Hay, A |
| author_facet | Bryce, A Costelloe, C Wootton, M Butler, C Hay, A |
| author_sort | Bryce, A |
| collection | OXFORD |
| description | <h4>Background</h4> <p>All-cause antibiotic prescribing affects bowel flora antimicrobial susceptibility, and may increase risk of urinary autoinoculation with antibiotic-resistant microbes. However, little is known about relative prevalence of, or risk factors for, antimicrobial resistance among potentially pathogenic microbes thought to be contaminating and infecting urine.</p> <h4>Methods</h4> <p>Secondary analysis of 824 children under 5 years of age consulting in primary care for an acute illness and their Escherichia coli isolates cultured at ≥103 cfu/mL fromthe Diagnosis of Urinary Tract infection in Young children (DUTY) study. Multivariable logistic regression investigating risk factors for resistance to amoxicillin, co-amoxiclav, cefalexin, ciprofloxacin, trimethoprim, nitrofurantoin and cefpodoxime in microbes meeting the laboratory criteria for urinary tract infection: ‘pathogens’ (>105 cfu/mL, n=79) and ‘contaminants’ (103 to 105 cfu/mL, n=745).</p> <h4>Results</h4> <p>Forty-three percent of E. coli were resistant to at least one tested antibiotic, with resistance highest to amoxicillin (49.37% pathogenic versus 37.32% contaminant, P=0.04), trimethoprim (27.85% versus 16.52%, P=0.01) and co-amoxiclav (16.46% versus 21.48%, P=0.30). Multidrug resistance (to ≥3 antibiotic groups) was present in 17.07% of pathogens and 30.13% of contaminants (P=0.04). No isolates were resistant to nitrofurantoin. Recent (0–3months) exposure to antibiotics was associated with resistance in both pathogens (aOR: 1.10, 95% CI: 1.01–4.39) and contaminants (1.69, 1.09–2.67).</p> <h4>Conclusions</h4> <p>Prevalence of resistance (including multidrug) was high, but there was no consistent relationship between isolate pathogen/contamination status and resistance. Recent all-cause antibiotic prescribing increased the probability of antimicrobial resistance in both pathogenic and contaminating urinary E. coli in children in primary care.</p> |
| first_indexed | 2024-03-07T00:55:17Z |
| format | Journal article |
| id | oxford-uuid:87dc4093-6bb8-416f-824d-a357645ced1d |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T00:55:17Z |
| publishDate | 2018 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:87dc4093-6bb8-416f-824d-a357645ced1d2022-03-26T22:13:22ZComparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:87dc4093-6bb8-416f-824d-a357645ced1dEnglishSymplectic Elements at OxfordOxford University Press2018Bryce, ACostelloe, CWootton, MButler, CHay, A <h4>Background</h4> <p>All-cause antibiotic prescribing affects bowel flora antimicrobial susceptibility, and may increase risk of urinary autoinoculation with antibiotic-resistant microbes. However, little is known about relative prevalence of, or risk factors for, antimicrobial resistance among potentially pathogenic microbes thought to be contaminating and infecting urine.</p> <h4>Methods</h4> <p>Secondary analysis of 824 children under 5 years of age consulting in primary care for an acute illness and their Escherichia coli isolates cultured at ≥103 cfu/mL fromthe Diagnosis of Urinary Tract infection in Young children (DUTY) study. Multivariable logistic regression investigating risk factors for resistance to amoxicillin, co-amoxiclav, cefalexin, ciprofloxacin, trimethoprim, nitrofurantoin and cefpodoxime in microbes meeting the laboratory criteria for urinary tract infection: ‘pathogens’ (>105 cfu/mL, n=79) and ‘contaminants’ (103 to 105 cfu/mL, n=745).</p> <h4>Results</h4> <p>Forty-three percent of E. coli were resistant to at least one tested antibiotic, with resistance highest to amoxicillin (49.37% pathogenic versus 37.32% contaminant, P=0.04), trimethoprim (27.85% versus 16.52%, P=0.01) and co-amoxiclav (16.46% versus 21.48%, P=0.30). Multidrug resistance (to ≥3 antibiotic groups) was present in 17.07% of pathogens and 30.13% of contaminants (P=0.04). No isolates were resistant to nitrofurantoin. Recent (0–3months) exposure to antibiotics was associated with resistance in both pathogens (aOR: 1.10, 95% CI: 1.01–4.39) and contaminants (1.69, 1.09–2.67).</p> <h4>Conclusions</h4> <p>Prevalence of resistance (including multidrug) was high, but there was no consistent relationship between isolate pathogen/contamination status and resistance. Recent all-cause antibiotic prescribing increased the probability of antimicrobial resistance in both pathogenic and contaminating urinary E. coli in children in primary care.</p> |
| spellingShingle | Bryce, A Costelloe, C Wootton, M Butler, C Hay, A Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. |
| title | Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. |
| title_full | Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. |
| title_fullStr | Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. |
| title_full_unstemmed | Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. |
| title_short | Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study. |
| title_sort | comparison of risk factors for and prevalence of antibiotic resistance in contaminating and pathogenic urinary escherichia coli in children in primary care prospective cohort study |
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