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Risk factors for gentamicin-resistant E. coli in children with community-acquired urinary tract infection

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

According to many guidelines, gentamicin is the empirical parenteral treatment for children with community-acquired urinary tract infection (CA-UTI). However, increasing resistance rates are reported. The purpose of this study is to analyze risk factors for presenting with a UTI caused by a community-acquired gentamicin-resistant Escherichia coli in children in our hospital and to describe their clinical outcome. A retrospective case-control local study was performed in a tertiary care hospital from January 2014 to December 2016. Cases and controls were children below 14 years old diagnosed in the Emergency Department with febrile CA-UTI caused by gentamicin-resistant and gentamicin-susceptible febrile E. coli strains, respectively. During the study period, 54 cases were included and compared with 98 controls. Patients with chronic conditions were more likely to present with a UTI due to gentamicin-resistant E. coli (OR 3.27; 95% CI 1.37–7.8, p < 0.05), as well as children receiving antibiotic prophylaxis (OR 3.5; 95% CI 1.2–10.1, p < 0.05). Cases had longer hospital stays than controls (5.8 ± 5 days vs. 4.4 ± 4 days, p = 0.017). Gentamicin-resistant strains associated higher rates of cefuroxime (29% vs. 3%), cefotaxime (27% vs. 0%), and quinolone resistance (40.7% vs. 6%) (p < 0.01) and produced more frequently extended-spectrum beta-lactamases (ESBL) (20% vs. 0%, p < 0.01) and carbapenemases (7.4% vs. 0%; p = 0.015). All gentamicin-resistant strains were amikacin-sensitive. The presence of chronic conditions and antibiotic prophylaxis could be potential risk factors for gentamicin-resistant E. coli CA-UTI in children. Simultaneous resistance to cephalosporins, quinolones, and ESBL/carbapenemase production is frequent in these strains.

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Acknowledgments

Acknowledgment is given to Claire Marsden for the revision of the English language.

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Authors and Affiliations

  1. Pediatric Department, Autonoma University, Madrid, Spain

    Elsa Roldan-Masedo

  2. Pediatric Infectious and Tropical Diseases Department, Hospital La Paz Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain

    Talia Sainz, Luis Escosa, Fernando Baquero-Artigao & Ana Méndez-Echevarría

  3. Translational Research Network in Pediatric Infectious Diseases (RITIP), Paseo de la Castellana 261, 28046, Madrid, Spain

    Talia Sainz, Fernando Baquero-Artigao & Ana Méndez-Echevarría

  4. Microbiology Department, Hospital La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Almudena Gutierrez-Arroyo & Rosa Maria Gomez-Gil

  5. Pediatric Nephrology Department, Hospital La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Estefania Ballesteros

Authors
  1. Elsa Roldan-Masedo
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  2. Talia Sainz
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  3. Almudena Gutierrez-Arroyo
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  4. Rosa Maria Gomez-Gil
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  5. Estefania Ballesteros
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  6. Luis Escosa
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  7. Fernando Baquero-Artigao
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  8. Ana Méndez-Echevarría
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Correspondence to Ana Méndez-Echevarría.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. The study protocol was approved by the La Paz Hospital’s Ethics Committee.

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Roldan-Masedo, E., Sainz, T., Gutierrez-Arroyo, A. et al. Risk factors for gentamicin-resistant E. coli in children with community-acquired urinary tract infection. Eur J Clin Microbiol Infect Dis 38, 2097–2102 (2019). https://doi.org/10.1007/s10096-019-03643-7

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  • DOI: https://doi.org/10.1007/s10096-019-03643-7

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