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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. Background: All-cause antibiotic prescribing affects bowel flora antimicrobial susceptibility, and may increase risk of urinary autoinoculation with antibiotic-resistant microbes. However, little is known about relative prevalence of, or risk factors for, antimicrobial resistance among potentially pathogenic microbes thought to be contaminating and infecting urine. Methods: Secondary analysis of 824 children under 5 years of age consulting in primary care for an acute illness and their Escherichia coli isolates cultured at ≥10 3 cfu/mL from the Diagnosis of Urinary Tract infection in Young children (DUTY) study. Multivariable logistic regression investigating risk factors for resistance to amoxicillin, co-amoxiclav, cefalexin, ciprofloxacin, trimethoprim, nitrofurantoin and cefpodoxime in microbes meeting the laboratory criteria for urinary tract infection: 'pathogens' ( > 10 5 cfu/mL, n=79) and 'contaminants' (10 3 to 10 5 cfu/mL, n=745). Results: Forty-three percent of E. coli were resistant to at least one tested antibiotic, with resistance highest to 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). Multidrug resistance (to ≥3 antibiotic groups) was present in 17.07% of pathogens and 30.13% of contaminants (P=0.04). No isolates were resistant to nitrofurantoin. Recent (0-3months) exposure to antibiotics was associated with resistance in both pathogens (aOR: 1.10, 95% CI: 1.01-4.39) and contaminants (1.69, 1.09-2.67). Conclusions: Prevalence of resistance (including multidrug) was high, but there was no consistent relationship between isolate pathogen/contamination status and resistance. Recent all-cause antibiotic prescribing increased the probability of antimicrobial resistance in both pathogenic and contaminating urinary E. coli in children in primary care.

Original publication




Journal article


Journal of Antimicrobial Chemotherapy

Publication Date





1359 - 1367