Escherichia coli resistance patterns, empiric and targeted antibiotic prescriptions in children: a single center experience

Main Article Content

Danilo Buonsenso
Davide Pata
Barbara Fiori
Maurizio Sanguinetti
Anna Acampora
Vittoria Ferrari
Rossana Albano
Teresa Spanu
Piero Valentini

Keywords

Escherichia coli, antibiotics, resistance

Abstract

Background and aim: Antibiotic resistance represents one of the major public health issues, due to the potential future ineffectiveness of available antibiotics. However, epidemiological studies on E. coli antibiotic resistance patterns in the pediatric population are limited.


Methods: We conducted a retrospective analysis on children younger than 18 years of age admitted to the Department of Pediatrics from April 2016 to April 2018 with E. coli isolation on biological materials.


Results: 205 subjects were included in the study (mean age 1.6 years). We found an overall low rate of resistance of E. coli isolates to Amoxicil-lin/Clavulanate (20%), Cephalosporins (6.3%) and Aminoglycosides (6.3%), while no isolates were resistant to Carbapenems. Presence of invasive devices and intensive care admissions were as-sociated with resistance to Cephalosporines (P < 0.001; OR 9.21, 95% CI 2.7 – 31.39) and Amino-glycosides (P < 0.004; OR 5.42, 95% CI 1.71 – 17.15), while no factors associated with resistance to the other antibiotics were found.


Conclusions: Aminoglycosides and Cephalosporins were frequently used as empiric therapy, whereas targeted therapies aimed at sparing these classes of antibiotics once antibiograms were available have not always been established. These data may inform local antimicrobial stewardship and guide the development of programs aiming at a better use of antibiotics.

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References

1. Kaper JB, Nataro JP, Mobley HL. Pathogenic Escherichia coli. Nat Rev Microbiol. 2004 Feb;2(2):123-40. doi: 10.1038/nrmicro818. PMID: 15040260.
2. Paitan Y. Current Trends in Antimicrobial Resistance of Escherichia coli. Curr Top Microbiol Immunol. 2018;416:181-211. doi: 10.1007/82_2018_110. PMID: 30088148.
3. Berglund B, Chen B, Tärnberg M, et al. Characterization of extended-spectrum β-lactamase-producing Escherichia coli harboring mcr-1 and toxin genes from human fecal samples from China. Future Microbiol. 2018 Nov;13:1647-1655. doi: 10.2217/fmb-2018-0242. Epub 2018 Nov 29. PMID: 30489158.
4. Chen B, Berglund B, Wang S, et al. Rapid increase in occurrence of carbapenem-resistant Enterobacteriaceae in healthy rural residents in Shandong province, China, from 2015 to 2017. J Glob Antimicrob Resist. 2021 Dec 8:S2213-7165(21)00258-7. doi: 10.1016/j.jgar.2021.11.007. Epub ahead of print. PMID: 34896338.
5. Ling TK, Liu EY, Cheng AF. A 13-year study of antimicrobial susceptibility of common gram-negative bacteria isolated from the bloodstream in a teaching hospital. Chemotherapy. 2001 Jan-Feb;47(1):29-38. doi: 10.1159/000048498. PMID: 11125230.
6. Losada I, Barbeito G, García-Garrote F, et al. Estudio de sensibilidad de Escherichia coli productores de infecciones del tracto urinario comunitarias en Galicia. Período: 2016-2017 [Antimicrobial susceptibility of Escherichia coli producers of community urinary tract infections in Galicia (Spain). Period: 2016-2017]. Aten Primaria. 2020 Aug-Sep;52(7):462-468. Spanish. doi: 10.1016/j.aprim.2019.06.007. Epub 2019 Oct 11. PMID: 31607403; PMCID: PMC7393545.
7. Kurowski KM, Marusinec R, Amato HK, et al. Social and Environmental Determinants of Community-Acquired Antimicrobial-Resistant Escherichia coli in Children Living in Semirural Communities of Quito, Ecuador. Am J Trop Med Hyg. 2021 Jul 19;105(3):600-610. doi: 10.4269/ajtmh.20-0532. PMID: 34280150; PMCID: PMC8592365.
8. Martos I, Colucci Camusso G, Albornoz M, et al. Perfil etiológico y sensibilidad antimicrobiana en 1740 infecciones urinarias de la comunidad en la ciudad de Córdoba, Argentina [Etiological profile and antimicrobial sensitivity in 1740 urinary infections of the community in the city of Córdoba, Argentina.]. Arch Esp Urol. 2021 Sep;74(7):645-651. Spanish. PMID: 34472432.
9. Malchione MD, Torres LM, Hartley DM, Koch M, Goodman JL. Carbapenem and colistin resistance in Enterobacteriaceae in Southeast Asia: Review and mapping of emerging and overlapping challenges. Int J Antimicrob Agents. 2019 Oct;54(4):381-399. doi: 10.1016/j.ijantimicag.2019.07.019. Epub 2019 Jul 29. PMID: 31369812.
10. McCarthy M. Science academies of G7 nations call for action on antibiotic resistance and neglected tropical diseases. BMJ. 2015;350(apr30 11):h2346-2346. https://doi.org/10.1136/bmj.h2346 PMID: 25929670
11. Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. Committee on Infectious Diseases, American Academy of Pediatrics. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. 2021 Jan. ISBN 978-1-61002-578-2. doi: 10.1542/9781610025782.
12. World Health Organization. (‎2012)‎. The evolving threat of antimicrobial resistance: options for action. World Health Organization. Available at https://apps.who.int/iris/handle/10665/44812. Accessed November 23, 2020.
13. Cassini A, Högberg LD, Plachouras D, et al.; Burden of AMR Collaborative Group. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis. 2019 Jan;19(1):56-66. doi: 10.1016/S1473-3099(18)30605-4
14. Medernach RL, Logan LK. The Growing Threat of Antibiotic Resistance in Children. Infect Dis Clin North Am. 2018 Mar;32(1):1-17. doi: 10.1016/j.idc.2017.11.001.
15. Available at www.epicentro.iss.it/resistenza_antibiotici/ar-iss/rapporto-1-dati-2018.pdf. Accessed November 19, 2020.
16. Balighian E, Burke M. Urinary Tract Infections in Children. Pediatr Rev. 2018 Jan;39(1):3-12. doi: 10.1542/pir.2017-0007. PMID: 29292282.
17. Wernli D, Jørgensen PS, Harbarth S, et al. Antimicrobial resistance: The complex challenge of measurement to inform policy and the public. PLoS Med. 2017 Aug 17;14(8):e1002378. doi: 10.1371/journal.pmed.1002378. PMID: 28817562; PMCID: PMC5560527.
18. de Kraker ME, Stewardson AJ, Harbarth S. Will 10 Million People Die a Year due to Antimicrobial Resistance by 2050? PLoS Med. 2016 Nov 29;13(11):e1002184. doi: 10.1371/journal.pmed.1002184. PMID: 27898664; PMCID: PMC5127510.