Clinical features of pediatric invasive Escherichia coli disease: A study at seven facilities in Chiba prefecture in Japan.

Abstract

Background: Escherichia coli is a major pathogen of pediatric invasive diseases; infection with multidrug-resistant strains needs immediate attention. The incidence and clinical characteristics of invasive E. coli disease (IED) in Japanese pediatric populations remain unclear. We aimed to investigate clinical and epidemiological characteristics of pediatric IED.

Methods: We retrospectively studied hospitalized patients aged ≤15 years diagnosed with IED between 2009 and 2022 at seven medical facilities in Chiba Prefecture, Japan. IED was defined as E. coli isolated from sterile sites, excluding cases with urine as the sole isolation site. Clinical data, antimicrobial susceptibility, outcomes, and estimated incidence rates were analyzed.

Results: A total of 172 IED episodes were identified in 162 patients, 86 % of which were in children aged <5 years, and 65 % had comorbidities. Urinary tract infections (UTIs) with bacteremia were the most common diagnoses. However, trends varied by age, with UTIs accompanied by bacteremia being the most common in patients aged <5 years, whereas bacteremia alone was the most common diagnosis in those aged ≥5 years. Death or other sequalae were observed in 21 (12.2 %) patients. Extended-spectrum β-lactamase (ESBL)-producing strains caused 12.2 % of infections, mostly affecting infants. Recurrence occurred in six patients, with five having comorbidities. Female sex was an independent risk factor for poor outcomes (odds ratio 3.115, p = 0.039).

Conclusions: Pediatric IEDs are more frequent in children with comorbidities, and they vary in clinical features according to the age group. ESBL-producing strains should be considered in empiric therapy, particularly in infants.