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Host characteristics, portal of entry common determinants of E. coli bacteremia
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Escherichia coli bacteremia severity in children is most commonly determined by host characteristics and portal of entry, according to recent study findings from Paris.
“Few data are available about E. coli bacteremia in children despite its frequency and severity,” the researchers wrote in a recent issue of The Pediatric Infectious Disease Journal. “To our knowledge, this is the first report combining bacterial and host characteristics in E. coli bacteremia in children.”
Erick Denamur, MD, PhD, of the Universités Paris Diderot et Paris Nord, and colleagues evaluated 84 children aged 18 years or younger with E. coli bacteremia to compare characteristics in source bacteremia, children 3 months or younger vs. 3 months or older, and in children vs. adults. Participants from this study are part of the COLIBAFI study, which is a large prospective, observational study including 1,051 adults and 84 children with E. coli bacteremia conducted in 15 French hospitals between January 2005 and November 2007.
Sixty-six percent of the portals of entry were the urinary tract compared with 19.5% of the digestive tract. Ten percent of participants were immunocompromised, 16.7% were transferred to the intensive care unit, 9.5% died during follow-up and 20.2% had severe bacteremia.
More than half (63.1%) of the isolates were resistant to amoxicillin while susceptibility was found for ofloxacin (96.4%) and gentamicin (96.4%). Resistance to third-generation cephalosporins (3.6%) was also found, however none of the isolates were resistant to imipenem compared with 34.5% that were resistant to cotrimoxazole. Multidrug resistance was found among 3.6% of isolates.
Overall, Seventy-two percent of patients were aged 3 months or younger compared with 41.5% of patients older than 3 months. Patients aged 3 months or younger were also less frequently immunocompromised compared with patients older than 3 months (P=.002).
Significant differences were not found between the age groups for portals of entry. Patients aged 3 months or younger were also more frequently diagnosed with severe bacteremia (P=.006). There were lower rates of antimicrobial resistance among patients aged 3 months or younger (P=.01).
Forty-five children had community-acquired urinary-source bacteremia compared with 513 adults from the COLIBAFI study. Adults were found to have severe bacteremia more frequently than children (P=.01).
“We found that bacteremia in children were less severe, but involved strains exhibiting a specific repertoire of virulence genes and being more resistant than those isolated in adults,” the researchers wrote. “Children are usually considered to be more susceptible to infections due to an immature immune system. This apparently contra intuitive result might be explained by comorbidities in the adult group (23.9% of adults were immunocompromised, and only 4.9% of children).”
Disclosure: The study was funded in part by the Projet Hospitalier de Rocherche Clinique and the Réseau de Recherche Clinique.
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