Paediatric Escherichia coli urinary tract infection: susceptibility trends and clinical management-a retrospective analysis of a 10-year period

Seán Olann Whelan; Sarah Kyne; Andrew Dore; Mark Glynn; Frances Higgins; Belinda Hanahoe; Frank Moriarty; Edina Moylett; Martin Cormican

doi:10.1007/s11845-024-03670-0

Paediatric Escherichia coli urinary tract infection: susceptibility trends and clinical management-a retrospective analysis of a 10-year period

Ir J Med Sci. 2024 Apr 3. doi: 10.1007/s11845-024-03670-0. Online ahead of print.

Authors

Seán Olann Whelan^{1

2}, Sarah Kyne³, Andrew Dore³, Mark Glynn³, Frances Higgins⁴, Belinda Hanahoe⁴, Frank Moriarty⁵, Edina Moylett^{3

6}, Martin Cormican^{4

7}

Affiliations

¹ Division of Clinical Microbiology, Galway University Hospitals, Galway, Ireland. s.whelan@rocketmail.com.
² Department of Microbiology, CHI at Temple Street, Dublin, Ireland. s.whelan@rocketmail.com.
³ Department of Paediatrics, Galway University Hospitals, Galway, Ireland.
⁴ Division of Clinical Microbiology, Galway University Hospitals, Galway, Ireland.
⁵ School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
⁶ Department of Paediatrics, University of Galway, Galway, Ireland.
⁷ Division of Bacteriology, University of Galway, Galway, Ireland.

PMID: 38565823
DOI: 10.1007/s11845-024-03670-0

Abstract

Background: Escherichia coli is the predominant urinary pathogen in children. Irish and international studies have demonstrated increasing antimicrobial resistance (AMR) to antibiotics such as co-amoxiclav.

Aims: We aimed to (1) examine the AMR patterns of paediatric urinary E. coli isolates, from both hospital and community sources, over a 10-year period; (2) assess the effectiveness of Children's Health Ireland (CHI) antimicrobial guidance given local susceptibility data; and (3) review the clinical management of an admitted patient sub-set over a 6-year period.

Methods: Pure growth of urinary E. coli from patients aged ≤ 14 from 2012 to 2021 were analysed for AMR. Differences in susceptibility rates were assessed. A retrospective chart review conducted on inpatients aged ≥ 2 months to ≤ 14 years, 2016-2021.

Results: E. coli accounted for 70.8% of likely significant positive pure growth cultures (9314 isolates). Susceptibility to co-amoxiclav significantly increased over time, from 66.7% to 80.4% (2016-2021, p < 0.001). Nitrofurantoin and cefalexin had significantly higher susceptibility rates than trimethoprim (< 70% annually). 85.1% of isolates were susceptible to the combination of co-amoxiclav and gentamicin, recommended for those > 2months and systemically unwell. The additional gain in empiric susceptibility provided by gentamicin above that provided by co-amoxiclav alone has fallen from 16.4% to 6.7% (2016-2021). The 222 clinical cases reviewed showed improved antimicrobial guideline compliance over time.

Conclusions: This study provides important regional AMR data. Co-amoxiclav susceptibility increased significantly over time, contrasting with previous studies. This was temporally associated with stewardship measures reducing co-amoxiclav prescribing. Decreasing utility of gentamicin supports recent CHI guideline updates reducing gentamicin use.

Keywords: Antimicrobial guidance; Antimicrobial resistance; Paediatrics; Urinary tract infection.