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Multiresistant E. coli urine infections in children: a case–control study
  1. Gayathri Raman1,2,
  2. Brendan McMullan3,
  3. Peter Taylor4,
  4. Kylie-Ann Mallitt2,
  5. Sean E Kennedy1,2
  1. 1Department of Paediatric Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia
  2. 2School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3Department of Paediatric Infectious Diseases, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
  4. 4SEALS Pathology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
  1. Correspondence to Dr Sean E Kennedy, Department of Nephrology, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; sean.kennedy{at}unsw.edu.au

Abstract

Objective Urinary tract infections (UTIs) caused by resistant organisms are increasing which poses challenges when selecting empirical antimicrobial therapy. The aim of this study is to determine risk factors for multiresistant Escherichia coliUTIs in children.

Design We included all reported urinary isolates from a children’s hospital collected between January 2010 and June 2013. Patients who had multiresistant E. coliUTIs were identified and a retrospective review of medical records performed. Patient-specific clinical and demographic factors were compared with age-matched and gender-matched controls with non-multiresistant E. coliUTIs. Univariable and multivariable statistical analysis were performed to determine significant risk factors for multiresistant organism E.coliUTIs.

Results In total, there were 2692 positive urine cultures, 1676 (62.3%) from 1169 patients were E. coli. Multiresistant E. coli was isolated from 139 (8.3% of all E. coli) cultures in 99 patients. Thirteen incomplete medical records were excluded, leaving 86 patients, matched with 86 controls. In multivariable regression, the only significant risk factor was antibiotic use in the previous month (adjusted OR 3.0, 95% CI 1.4 to 6.2), but not previous hospital admission (adjusted OR 1.4, 95% CI 0.6 to 2.9), being an inpatient at the time of diagnosis (adjusted OR 2.4, 95% CI 0.8 to 7.4) and previous instrumentation (adjusted OR 1.0, 95% CI 0.4 to 2.4).

Conclusions This is the first case–control study to examine multiresistant UTI in Australian children. Clinicians should be judicious in the use of antibiotics in treatment and prophylaxis of UTIs. In children presenting with UTI and recent antibiotic exposure, amoxicillin-clavulanic acid appears to be an appropriate empiric antibiotic choice in our population.

  • Anti-Bacterial agents

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Footnotes

  • Contributors SK initially proposed the idea for the project, the study design and was the main supervisor of GR. GR performed the literature review, collected and analysed data and wrote the draft manuscript. Data analysis was supported by KAM, biostatistician. PT supplied data and contributed to data analysis. BM, SK and PT were involved in writing the final manuscript. The guarantor of this paper is SK.

  • Competing interests None declared.

  • Ethics approval Human Research Ethics Committee at the Sydney Children’s Hospital Network and the SESIAHS Northern Hospital Network.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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