title: Risk Factors For and Outcomes of Multidrug-Resistant Escherichia coli Infections in Children.
abstract: BACKGROUND
  The recent increase in multidrug-resistant (MDR) Escherichia coli infections is not well described in children. We determined the risk factors and outcomes of extraintestinal E. coli infections in children in our region.
  
  
  METHODS
  We conducted a retrospective cohort study of children ≤18 years in Olmsted County, MN, USA, between January 1, 2012 and December 31, 2012. MDR isolates were defined as resistant to ≥3 antibiotic classes.
  
  
  RESULTS
  A total of 368 children each contributed 1 isolate. Isolates were predominantly community-associated (82%) and from urine (90%), and outpatients (86%); 46 (13%) isolates were MDR. In multivariable analysis, genitourinary (GU) tract anomaly (OR 2.42, 95% CI 1.03-5.68), invasive devices (OR 3.48, 95% CI 1.37-8.83) and antibiotic use at presentation (OR 2.62, 95% CI 1.06-6.47) were associated with MDR E. coli. Children with MDR infections were more likely to have a complex infection (35% vs. 17%, P = 0.026), less likely to receive effective empiric antibiotics (47% vs. 74%, P < 0.001), had longer time to receipt of effective antibiotics (median 19.2 vs. 0.6 h, P < 0.001), and longer hospitalization (median 10 vs. 4 days, P = 0.029) than children with non-MDR infections.
  
  
  CONCLUSIONS
  Pediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.
authors.affiliation: Pediatric Infectious Diseases Section, Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA. didiora@yahoo.com.
authors.forename: Adaora S
authors.initials: AS
authors.lastname: Uzodi
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Ritu
authors.initials: R
authors.lastname: Banerjee
keywords: Antimicrobial resistance; E. coli; Multidrug-resistant E. coli