Pediatric Nephrology

, Volume 31, Issue 8, pp 1305–1312 | Cite as

Urinary tract infection in infants caused by extended-spectrum beta-lactamase-producing Escherichia coli: comparison between urban and rural hospitals

  • Ming-Fang Cheng
  • Wan-Ling Chen
  • I-Fei Huang
  • Jung-Ren Chen
  • Yee-Hsuan Chiou
  • Yao-Shen Chen
  • Susan Shin-Jung Lee
  • Wan-Yu Hung
  • Chih-Hsin Hung
  • Jiun-Ling Wang
Original Article



Community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging problem. Compared with urban infants, rural infants may encounter different distributions of community-acquired resistant strains and various barriers to efficient management.


A retrospective survey and comparison was conducted for infants with UTI caused by ESBL-producing E. coli admitted to an urban hospital (n = 111) and a rural hospital (n = 48) in southern Taiwan from 2009 to 2012.


Compared with 2009 and 2010, the total number of cases at both hospitals significantly increased in 2011 and 2012 (p < 0.001). Compared with the rural patients, the urban patients were significantly younger, and they had fewer days of fever before and after admission, fewer presentations of poor activity and poor appetite, and a lower serum creatinine level. Most of the patients had no prior history of illness, and we could not identify any significant different risk factors for acquiring ESBL-producing E. coli, such as past antimicrobial use, hospitalization, UTI, and underlying renal diseases, between the urban and rural populations.


The increase in community-acquired UTI in infants caused by ESBL-producing E. coli was similar between the urban and rural populations. Our preliminary data suggest that the rural–urban disparities were probably related to easy access to health care by the urban population. ESBL complicates disease management, and the increase in the prevalence of ESBL producers is a major health concern and requires further healthy carrier and environmental surveillance.


Antimicrobial resistance Epidemiology Rural health Health disparity Child 



This study was supported by a grant (VGHKS104-082) from Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

Compliance with ethical standards

This study was approved by the Institutional Review Board (VGHKS13-CT1-01) of both hospitals.

Conflict of interest

The authors have no conflicts of interest to disclose


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Copyright information

© IPNA 2016

Authors and Affiliations

  • Ming-Fang Cheng
    • 1
    • 2
    • 3
  • Wan-Ling Chen
    • 1
    • 2
    • 4
  • I-Fei Huang
    • 1
    • 2
  • Jung-Ren Chen
    • 5
  • Yee-Hsuan Chiou
    • 1
    • 2
    • 3
  • Yao-Shen Chen
    • 2
    • 6
  • Susan Shin-Jung Lee
    • 2
    • 6
  • Wan-Yu Hung
    • 7
  • Chih-Hsin Hung
    • 7
  • Jiun-Ling Wang
    • 8
  1. 1.Department of PediatricsKaohsiung Veterans General HospitalKaohsiungTaiwan
  2. 2.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  3. 3.Fooyin UniversityKaohsiungTaiwan
  4. 4.Department of PediatricsPingtung Branch of Veterans General Hospital–KaohsiungPingtungTaiwan
  5. 5.Department of Biological Science and Technology, College of MedicineI-Shou UniversityKaohsiungTaiwan
  6. 6.Department of Internal MedicineKaohsiung Veterans General HospitalKaohsiungTaiwan
  7. 7.Department of Chemical Engineering and Institute of Biotechnology and Chemical EngineeringI-Shou UniversityDashu District, Kaohsiung CityTaiwan (R.O.C)
  8. 8.Department of Internal MedicineNational Cheng Kung University HospitalTainan CityTaiwan (R.O.C)

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