Background
Methods
Study population
Microbiological laboratory procedures
Screening for E. coli strains in stool samples
Antimicrobial susceptibility testing
Detection of O25b–ST131, multilocus sequence typing, and blaCTX-M gene groups
Statistical analysis
Results
Antimicrobial susceptibility testing
Non-susceptible rate % (number/total number) | ||||
---|---|---|---|---|
Total | MDR E. coli (n = 58) | Non MDR E. coli (n = 99) | p | |
Flormoxef | 7.6 (12/157) | 17.2 (10/58) | 2.0 (2/99) | 0.001 |
Ampicillin | 70.1 (110/157) | 100.0 (58/58) | 52.5 (52/99) | < 0.001 |
Amoxicillin/clavunate | 65.6 (103/157) | 96.6 (56/58) | 47.5 (47/99) | < 0.001 |
Cefazolin | 32.5 (51/157) | 77.6 (45/58) | 6.1 (6/99) | < 0.001 |
Cefuroxime | 22.9 (36/157) | 55.2 (32/58) | 4.0 (4/99) | < 0.001 |
Cefuroxime Axetil | 24.8 (39/157) | 55.2 (32/58) | 7.1 (7/99) | < 0.001 |
Cefoxitin | 15.3 (24/157) | 37.9 (22/58) | 2.0 (2/99) | < 0.001 |
Cefotaxime | 19.6 (31/157) | 46.6 (27/58) | 4.0 (4/99) | < 0.001 |
Ceftazidime | 13.4 (21/157) | 29.3 (17/58) | 4.0 (4/99) | < 0.001 |
Cefpirome | 8.3 (13/157) | 19.0 (11/58) | 2.0 (2/99) | < 0.001 |
Ertapenem | 0.0 (0/157) | 0.0 (0/58) | 0.0 (0/99) | NA |
Imipenem | 0.0 (0/157) | 0.0 (0/58) | 0.0 (0/99) | NA |
Amikin | 0.0 (0/157) | 0.0 (0/58) | 0.0 (0/99) | NA |
Gentamicin | 22.9 (36/157) | 60.3 (35/58) | 1.0 (1/99) | < 0.001 |
Ciprofloxacin | 18.5 (29/157) | 43.1 (25/58) | 4.0 (4/99) | < 0.001 |
Moxifloxacin | 19.1 (30/157) | 43.1 (25/58) | 5.1 (5/99) | < 0.001 |
Tigecycline | 0.0 (0/157) | 0.0 (0/58) | 0.0 (0/99) | NA |
Colistin | 0.6 (1/157) | 1.7 (1/58) | 0.0 (0/99) | 0.190 |
Trimethoprim-sulfamethoxazole | 47.1 (74/157) | 84.5 (49/58) | 25.3 (25/99) | < 0.001 |
ST 131 | Non ST 131 | |||
---|---|---|---|---|
O25b | NonO25b | O25b | NonO25b | |
ESBL + (n = 13) | 7 | 4 | 2 | 0 |
ESBL – (n = 144) | 3 | 3 | 14 | 124 |
Cipro R (n = 29) | 6 | 1 | 4 | 18 |
Cipro S (n = 128) | 4 | 2 | 12 | 110 |
MLST of E. coli isolates
ST131 positive % (number/total number) | |
---|---|
ESBL n = 13 | 53.6% (7/13) |
Non-ESBL n = 144 | 4.2% (6/144) |
P | < 0.001 |
Ciprofloxacin non-susceptible (n = 29) | 24.1% (7/29) |
Ciprofloxacin susceptible (n = 128) | 4.7% (6/128) |
P | 0.003 |
MDR (n = 58) | 13.8% (8/58) |
Non-MDR (n = 99) | 5.1% (5/99) |
P | 0.073 |
blaCTX-M gene study
E. coli
| Total number: 157 | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ESBL | Non-ESBL | |||||||||||||||||||
13 | 144 | |||||||||||||||||||
Type | O | NO | O | NO | ||||||||||||||||
No. | 9 | 4 | 17 | 127 | ||||||||||||||||
ST | 69 | 73 | 95 | 131 | NS | 69 | 73 | 95 | 131 | NS | 69 | 73 | 95 | 131 | NS | 69 | 73 | 95 | 131 | NS |
No. | 0 | 0 | 0 | 7 | 2 | 0 | 0 | 0 | 0 | 4 | 1 | 0 | 0 | 3 | 13 | 9 | 5 | 5 | 3 | 105 |
CTX-M-G1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 |
CTX-M-G1 CTX-M-(3,15) | 0 | 0 | 0 | 3 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
CTX-M-G2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
CTX-M-G8 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
CTX-M-G9 CTX-M-14 | 0 | 0 | 0 | 4 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 2 | 2 | 0 | 0 | 0 | 5 |
Non-CTX-M-group-(1,2,8,9) | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 0 | 2 | 0 | 0 | 0 | 2 | 11 | 7 | 5 | 5 | 2 | 98 |
Discussion
Country (published years) | First author | Study population | Setting | Sample size | Prevalence of resistance |
---|---|---|---|---|---|
Houston, Tex USA (1987) [23] | Reves RR | Children | Cross-section, day-care centers | 79 | trimethoprim: 37%; ampicillin: 70% |
Bolivia (1998) [24] | Bartoloni A | aged 6–72 months | healthy children; community-based | 296 | Ampicillin: 97% TMP/SMX: 94%, Cephalothin:10% Tetracycline: 92% Ciprofloxacin: 0% |
Shanghai, China (1998) [25] | Zhang XL | Group A: Children of 5–6 years Group B: Children of 10–11 years | A: Nursery school B: Primary school | A: 30 B: 54 | A: Ampicillin: 93.3% Trimethoprim: 100% Ciprofloxacin: 43.3% B: Ampicillin: 100% Trimethoprim: 100% Ciprofloxacin: 53.7% |
Mexican (2003) [26] | Zaidi MB | healthy children (1 month to 12 years) | day care centers or kindergartens | 276 | nalidixic acid: 54% ciprofloxacin: 18.5% |
Bolivia and Peru (2006) [27] | Bartoloni A | children (aged 6 to 72 months) | Health children in four urban area | 3174 | Ampicillin: 95%, trimethoprim-sulfamethoxazole: 94% nalidixic acid: 35% gentamicin: 21% ciprofloxacin: 18% ceftriaxone: 0.1% amikacin: 0.1% |
Germany (2007) [28] | Lietzau S | children aged 6 months to 4 years | regular health screening or an acute infection | 884 | Ampicillin: 16.6% amoxicillineclavulanic acid: 8% cotrimoxazole: 8.7% Nalidixic acid: 2.0% Levofloxacin: 0.4% |
India (2009) [29] | Seidman JC | aged 5–10 years | primary school children | 119 | Cefazoline: 6.7% (8/119) ampicillin: 38.7% (46/119) cotrimoxazole: 37.0% (44/119) Ciprofloxacin: 12.6% (15/119) Cefotaxime: 4.2% (5/119) |
Senegal (2009) [30] | Ruppé E | aged 1 to 11 years | healthy children | 20 | ESBL-producing: 10% |
Portugal (2009) [31] | Guimaraes B | Aged 1 to 14 years | healthy children | 112 | ESBL-positive: 2.7% |
Vietnam (2012) [32] | Dyar OJ | child aged 6–60 months | rural children (1% with diarrhea) | 818 | Ampicillin: 65% co-trimoxazole: 68% ciprofloxacin: < 1% |
Guinea-Bissau (2012) [33] | Isendahl J | children < 5 years of age | fever or tachycardia attending a pediatric emergency ward | 408 | ESBL-producing E coli: 20.34% (83/408) |
Sweden (2013) [34] | Kaarme J | Children (range 11–66 months) 66 months | preschool | 313 | ESBL-producing E coli: 2.6% (8/313) |
Libyan (2014) [35] | Ahmed SF | children aged from 3 to 12 years | Diarrhea attending outpatient clinics | 134 | Ampicillin: 78.4% Amoxicillin/Clavulanic: 64.2% TMP/SMZ: 61.9% Cefotaxime: 20.2% Ciprofloxacin: 5.2% ESBL-producing E coli: 13.4% (18/134) |
France (2014) [36] | Blanc V | Children (3 and 40 months) | Day-care center | 419 | ESBL-producing E coli: 6.4% |
Spain (2014) [37] | Fernández-Reyes M | children at the ages of 8, 12, and 16 months | healthy children in the community | 125 | ESBL-producing E coli: 24% of 125 children and 10.7% of the 318 fecal samples |
Lao People’s Democratic Republic (2015) [38] | Stoesser N | children ≤6 years of age | preschool childcare facilities | 397 | ESBL-producing E coli: 19.65% (78/397) Amoxicillin/clavulanate: 10.33% (41/397) Co-trimoxazole: 14.61% (58/397) Cefotaxime: 19.4% (77/397) Ofloxacin: 3.78% (15/397) |