September 12, 2019
2 min read

Maternal quinolone exposure increases risk for resistant infection in child

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Children whose mothers received antimicrobial therapy with quinolones faced an approximately 50% increased risk for quinolone-resistant bacteriuria, according to a study of more than 40,000 children published in Clinical Infectious Diseases.

“A possible source of exposure to quinolones could be other quinolone users in the child’s environment, and the household is the most immediate surrounding,” Bat-Sheva Gottesman, MD, from the infectious diseases unit at Meir Medical Center in Israel, and colleagues wrote. “We chose to study the influence of the mothers’ quinolone consumption as a test-case for household exposure, as she is usually the child’s closest contact.”

According to the researchers, researchers previously described an association between gut colonization with ciprofloxacin-resistant Escherichia coli in healthy children and their mothers, but the relationship between maternal consumption and clinically relevant resistance patterns in their children is unclear.

Gottesman and colleagues conducted a population-based, unmatched case-control study between 2010 and 2017. They compared children aged 0.5 to 17 years with community-acquired, gram-negative, quinolone-resistant bacteriuria with children with quinolone-sensitive bacteriuria.

The researchers included only first-positive urine cultures for each child and collected data on maternal quinolone prescriptions and children’s antibiotic use, age, sex, ethnicity and previous hospitalizations.

Of the 40,204 children included in the study, quinolone resistance was detected in urine cultures in 5.3%. More than half of the children included in the study (n = 26,937; 65%) received any antibiotic, and 3.2% of mothers received quinolones no longer than 6 months before their child’s bacteriuria.

Gottesman and colleagues found that independent risk factors for quinolone-resistant bacteriuria included maternal quinolone use (OR = 1.5; 95% CI, 1.22-1.85), Arab ethnicity (OR = 1.99; 95% CI, 1.81-2.19) and prescribing any antibiotics to children (OR = 1.54; 95% CI, 1.38-1.71). They said younger children had a 1.33 to 1.43 increased odds for quinolone-resistant bacteriuria compared with older children aged 12 to 17 years.

According to the researchers, studying the effect of parental antibiotic use on children in the household can be difficult because children are often prescribed antibiotics. They said that, because quinolones are rarely used in pediatric patients, they could isolate quinolone use.

“A possible hypothesis to explain our results is that quinolone consumption by mothers led to gut colonization of the mother with quinolone-resistant bacteria, which were transmitted to their offspring,” they wrote. “This resulted in resistant bacteria colonization in the child, serving as a reservoir for ensuing clinical infection.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.