Original Article
Household contacts were key factor for children's colonization with resistant Escherichia coli in community setting

https://doi.org/10.1016/j.jclinepi.2007.01.016Get rights and content

Abstract

Objective

In young children infections with resistant Escherichia coli (E. coli) can lead to life-threatening situations. Epidemiological data on the prevalence and major determinants of carriage of antibiotic resistant E. coli among children in the community setting are sparse.

Study Design and Setting

In a population-based study from Germany, stool samples were obtained from children aged 6 months to 4 years attending a pediatrician for a regular health screening (N = 568) or an acute infection (N = 316), as well as from their parents (N = 1,594) and siblings (N = 624). E. coli was cultured, and minimal inhibitory concentrations to various antibiotics were tested. We determined prevalences of E. coli resistance to commonly prescribed antibiotics and their association with potential risk factors.

Results

Prevalence of E. coli resistance was 16.6%, 8.7%, and 11.6% for ampicillin, cotrimoxazole, and doxycycline, respectively. Strong associations were found with antibiotic resistance among siblings (odds ratios [95% confidence intervals] for ampicillin, doxycycline, and cotrimoxazole resistance: 4.4 [1.8–10.8], 8.0 [3.0–21.2], and 10.8 [3.5–32.7], respectively).

Conclusion

Resistance prevalences in this community-based study were much lower than those reported from the clinical sector. Household contacts seem to be the key factor for children`s colonization with resistant E. coli in the community setting.

Introduction

Antibiotic resistance is an emerging problem worldwide, and this applies also for Escherichia coli[1], [2], [3]. Especially in infants and small children, infections with resistant bacteria can lead to life-threatening situations [4], [5], [6], [7]. Nevertheless, epidemiological data on prevalence and determinants of antibiotic resistance in young children, particularly studies in the community setting, are very sparse.

The primary reservoir for antibiotic resistant E. coli, an important pathogen for common childhood infections, is the gut [8]. Different factors are thought to influence the prevalence of resistant bacteria in children. It was suggested that previous antibiotic intake affects the fecal flora [9], [10], [11], but results were not entirely consistent [12], [13]. Furthermore, spread of resistant bacteria within hospitals and day care centers was discussed as a major risk factor for the colonization with resistant isolates [14], [15]. There is also evidence that intrafamilial transmission is involved in the acquisition of resistant bacteria, but quantitative data on the importance of this factor are very sparse. Two small studies investigating the risk of intrafamilial transmission collected stool samples of household members of the study participants [12], [16]. Both studies found clustering of trimethoprim resistant E. coli within families.

The aim of this community-based study was to assess prevalence and determinants of antibiotic resistance of E. coli isolates cultured from fecal samples of a large population of healthy and infected children in the community setting. To investigate the potential role of intrafamilial transmission compared to other risk factors in a quantitative manner, information and stool samples from household members were also obtained.

Section snippets

Study population and data collection

From July 2002 to July 2003, children aged 6 months to 4 years who visited one of the 10 cooperating pediatricians in the city of Ulm, located in Southern Germany, for a regular health screening (offered to all children in Germany at ages 6–7, 10–12, 21–24, and 43–48 months and attended by more than 90% of all children) or because of an acute infection were eligible for recruitment (further referred to as “study children”). The attending parent and further family members were also asked to

Results

Altogether, 568 children (64.2%) attended the practice for a regular health screening examination, and 316 children (35.8%) came to pediatric practice due to a febrile infection. From these 884 children, 786 (88.9%) stool samples were sent to the study laboratory after the baseline examination. After 7–10 days, a second stool sample of 285 (90.2%) of the infected children arrived in the study laboratory. At least one stool sample was received from 796 children. E. coli could be cultured from

Discussion

Our study conducted in a community setting in Germany showed that prevalence of E. coli resistance still seemed to be relatively low and that there were no major differences between the prevalence patterns in parents and children. Furthermore, carriage of antibiotic resistant E. coli by parents, and particularly by siblings, was found to be the key risk factor for E. coli resistance among toddlers.

Studies looking at prevalences of resistant E. coli in outpatient children are rare. Studies from

Acknowledgments

The study was funded by the Baden-Württemberg state foundation. The foundation was not involved in the study design, collection, analysis, or interpretation of data, writing of the paper, or the decision to submit the paper for publication.

References (24)

  • W. Brumfitt et al.

    Antibiotic-resistant Escherichia coli causing urinary-tract infection in general practice: relation to faecal flora

    Lancet

    (1971)
  • O. Cars et al.

    Variation in antibiotic use in the European Union

    Lancet

    (2001)
  • W. Goettsch et al.

    Increasing resistance to fluoroquinolones in Escherichia coli from urinary tract infections in the Netherlands

    J Antimicrob Chemother

    (2000)
  • D.H. Howard et al.

    The global impact of drug resistance

    Clin Infect Dis

    (2003)
  • D.M. Livermore

    Bacterial resistance: origins, epidemiology, and impact

    Clin Infect Dis

    (2003)
  • B. Jakobsson et al.

    Renal scarring after acute pyelonephritis

    Arch Dis Child

    (1994)
  • U. Jodal

    The natural history of bacteriuria in childhood

    Infect Dis Clin North Am

    (1987)
  • J. Larcombe

    Urinary tract infection in children

    BMJ

    (1999)
  • S.R. Siegel et al.

    Urinary infection in infants and preschool children. Five-year follow-up

    Am J Dis Child

    (1980)
  • U.D. Allen et al.

    Risk factors for resistance to “first-line” antimicrobials among urinary tract isolates of Escherichia coli in children

    CMAJ

    (1999)
  • A.E. Macias et al.

    Antibiotic-resistant fecal Escherichia coli in healthy children. Induced by the use of antibiotics?

    Rev Invest Clin

    (2002)
  • B.E. Murray et al.

    Emergence of high-level trimethoprim resistance in fecal Escherichia coli during oral administration of trimethoprim or trimethoprim-sulfamethoxazole

    N Engl J Med

    (1982)
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