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Bacterial resistance may persist for up to three months after treatment in children

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Antibiotic resistance in children’s E. coli, a bacteria that is the most common cause of urinary tract infection, is high against many antibiotics commonly prescribed in primary care and could make them ineffective as first-line treatments, warns a study led by researchers at the Universities of Bristol and Oxford with Imperial College London.

Antibiotic resistance is one of the most serious global health threats faced in modern medicine. The threat of bacterial resistance has been compared to that of terrorism or pandemic flu by the Chief Medical Officer Dame Sally Davies. It has been estimated that by 2050, 10 million lives per year will be at risk from antibiotic-resistant infections. Children are frequent consumers of antibiotics worldwide - and such routine use has been shown to increase the probability of antibiotic resistance in adults with urinary tract infections. Yet little is known about the prevalence of bacterial resistance in children or the risk factors of importance in this group.

The research team investigated the prevalence of antibiotic resistance in urinary E. coli from pre-school children. E. coli is responsible for over 80% of all urinary tract infections (UTIs) in children. They also measured risk factors associated with resistant urinary E. coli, including previous antibiotic exposure.

They found a high prevalence of antibiotic resistance in urinary E. coli against several commonly prescribed antibiotics including amoxicillin, trimethoprim and co-amoxiclav. Almost one third of all E. coli were multidrug resistant (resistant to three or more antibiotic groups). There was also an association between exposure to antibiotics within the previous three months and increased likelihood of a resistant urinary E. coli.

The study, funded by the National Institute for Health Research School for Primary Care Research and published in the Journal of Antimicrobial Chemotherapy, involved secondary analysis of data from 824 children under 5 years consulting in primary care for an acute illness. The children had previously been recruited to the Diagnosis of Urinary Tract infection in Young children (DUTY) study, which aimed to improve the diagnosis of UTIs in children.

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.”

Dr Céire Costelloe from the NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, who co-led the research, said: “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.”

This study follows on from the team’s previous systematic review published in the BMJ in 2016 exploring the global prevalence of antibiotic resistance in children’s urinary tract infection caused by E. coli

Read more: 

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 by Ashley Bryce, Céire Costelloe, Mandy Wootton, Christopher C Butler and Alastair D Hay. Published in the Journal of Antimicrobial Chemotherapy. 29 January 2018. 

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