title: Urinary tract infection in infants caused by extended-spectrum beta-lactamase-producing Escherichia coli: comparison between urban and rural hospitals.
abstract: Community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging problem. Compared with urban infants, rural infants may encounter different distributions of community-acquired resistant strains and various barriers to efficient management.
  
  
  
  A retrospective survey and comparison was conducted for infants with UTI caused by ESBL-producing E. coli admitted to an urban hospital (n = 111) and a rural hospital (n = 48) in southern Taiwan from 2009 to 2012.
  
  
  
  Compared with 2009 and 2010, the total number of cases at both hospitals significantly increased in 2011 and 2012 (p < 0.001). Compared with the rural patients, the urban patients were significantly younger, and they had fewer days of fever before and after admission, fewer presentations of poor activity and poor appetite, and a lower serum creatinine level. Most of the patients had no prior history of illness, and we could not identify any significant different risk factors for acquiring ESBL-producing E. coli, such as past antimicrobial use, hospitalization, UTI, and underlying renal diseases, between the urban and rural populations.
  
  
  
  The increase in community-acquired UTI in infants caused by ESBL-producing E. coli was similar between the urban and rural populations. Our preliminary data suggest that the rural-urban disparities were probably related to easy access to health care by the urban population. ESBL complicates disease management, and the increase in the prevalence of ESBL producers is a major health concern and requires further healthy carrier and environmental surveillance.
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Fooyin University, Kaohsiung, Taiwan.
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Pediatrics, Pingtung Branch of Veterans General Hospital-Kaohsiung, Pingtung, Taiwan.
authors.forename: Wan-Ling
authors.initials: WL
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: I-Fei
authors.initials: IF
authors.lastname: Huang
authors.affiliation: Department of Biological Science and Technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Jung-Ren
authors.initials: JR
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Fooyin University, Kaohsiung, Taiwan.
authors.forename: Yee-Hsuan
authors.initials: YH
authors.lastname: Chiou
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, No. 1, Sec. 1, Syuecheng Rd., Dashu District, Kaohsiung City, 84001, Taiwan (R.O.C).
authors.forename: Wan-Yu
authors.initials: WY
authors.lastname: Hung
authors.affiliation: Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, No. 1, Sec. 1, Syuecheng Rd., Dashu District, Kaohsiung City, 84001, Taiwan (R.O.C). chhung@isu.edu.tw.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, No.1, University Road, Tainan City, 701, Taiwan (R.O.C). jiunlingwang@gmail.com.
authors.forename: Jiun-Ling
authors.initials: JL
authors.lastname: Wang
mesh_terms: D003430:Cross-Sectional Studies; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012189:Retrospective Studies; D012423:Rural Health; D014504:Urban Health; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology*; D018440:beta-Lactam Resistance
keywords: Antimicrobial resistance; Child; Epidemiology; Health disparity; Rural health