Methods: We conducted a population-based study using the Rochester Epidemiology Project (REP), a research infrastructure linking medical records of Olmsted County residents. Incident cases were children 0-18 years of age, residents of Olmsted County, with E. coli cultured from any extraintestinal source from 01/01/2012 through 12/31/2012. Polymicrobial cultures were included from all specimen types except urine. Incident urinary tract infection (UTI) cases were defined as subjects with monomicrobial E. coli cultured from urine at >105 CFU/ml, and fever, dysuria, or pyuria. MDR isolates were resistant to 3 or more antimicrobial drugs/drug classes
Results: There were 217 distinct children with E. coli infection (median age 7 years, 92% female, 97% with UTI). Incidence per 100,000 person-years was 535 overall, 519 for E. coli UTI and 6 for E. coli bloodstream infection (BSI). Incidence differed significantly by age group (p<0.001) and gender (p<0.001); and was highest among female infants and adolescents. Twenty-two (10%) children had MDR isolates and 76 (35%) had isolates resistant to 1-2 drug classes. MDR E. coli infection incidence was 53 per 100,000 person-years. Antimicrobial resistance was higher for ampicillin, ampicillin-sulbactam, trimethoprim-sulfamethoxazole and 1st generation cephalosporins than for other drug classes.
Conclusion: In our region of the US Midwest, the incidence of E. coli UTI and BSI in children in 2012 is higher than observed in previous years. E. coli isolates demonstrate increased resistance to 1st generation cephalosporins, commonly used first-line agents for treatment of E. coli UTI. Providers should be aware of the changing epidemiology of E. coli infections in children.
R. Banerjee, None