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a unwell child imageFebruary 8 2018

Antibiotic resistance in children’s E. coli is considered high against many antibiotics commonly prescribed in primary care, a new study has warned.

E coli is responsible for over 80% of all urinary tract infections (UTIs) in children. Researchers have found that 43% of E. coli were resistant to at least one tested antibiotic in a secondary analysis of DUTY study children’s urinary E. coli isolates. These were collected from 824 children aged 5 or younger.

The researchers from the University of Bristol and Imperial College London also measured risk factors associated with resistant urinary E. coli, including previous antibiotic exposure. The highest levels of resistance were found with:

  • amoxicillin (49.37% pathogenic versus 37.32% contaminant, P = 0.04),
  • trimethoprim (27.85% versus 16.52%, P = 0.01) and
  • co-amoxiclav (16.46% versus 21.48%, P = 0.30).

In addition, multidrug resistance (ie to three or more antibiotics) was found in 17.07% of pathogens and 30.13% of contaminants. There appeared to be no resistance involving nitrofurantoin.

Lead author, Dr Ashley Bryce, a Senior Research Associate at the Centre for Academic Primary Care, University of Bristol, said: “Our study shows that antibiotic resistance to this common bacteria found in children is high, especially when antibiotics have previously been recently prescribed.

“Frequent exposure to antibiotics can disrupt the normal balance of bacteria within the urinary tract and gut, which can lead to increased risk of bacterial infection. GPs should therefore consider the impact and necessity of further antibiotic treatment before prescribing.”

The National Institute for Health Research funded the study. Dr Céire Costelloe from the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, added: “Future research must prioritise increasing our understanding of antibiotic resistance in bacteria that commonly cause infections, so that prescribing guidelines can be updated to improve patient outcomes.”

Links:
University of Bristol announcement     
A Bryce et al. ‘Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study’. Journal of Antimicrobial Chemotherapy, dkx525. Published online January 29 2018             
NIHR announcement   

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