Clinical Infectious Diseases, 2019. [Epub ahead of print]
Gottesman BS1, Low M2, Almog R3, Chowers M4.
Background: Quinolone resistance has been documented in the paediatric population, although their use is limited in children. This study investigated the effect of maternal quinolone use on gram-negative bacterial resistance to quinolones in their offspring.
Methods: We conducted a population-based, unmatched case-control study during 2010-2017. Cases were all children ages 0.5-17 years with community acquired, gram-negative quinolone resistant bacteriuria. Controls were similar children with quinolone sensitive bacteriuria. Only first-positive urine cultures for each child were included. Data on quinolones dispensed to the mother, any antibiotics dispensed to the children, age, sex, ethnicity and prior hospitalizations were collected. Children with previous quinolone use were excluded.
Results: The study population consisted of 40,204 children. Quinolone resistance was detected in 2,182 (5.3%) of urine cultures. The median age was 5 years, with 93.7% females and 77.6% Jewish. A total of 26,937 (65%) of the children received any antibiotic and 1,359 (3.2%) of the mothers received quinolones in the 6 months preceding bacteriuria. Independent risk-factors were quinolone dispensed to the mothers [Odds Ratio (OR) 1.50, 95% Confidence Interval (CI) (1.22-1.85)], Arab ethnicity [OR 1.99, 95%CI (1.81-2.19)], and antibiotic dispensed to the child [OR 1.54 95%CI (1.38-1.71)]. Compared to children 12-17 years-of-age, younger children had 1.33-1.43 increased odds for quinolone-resistant bacteriuria.
Conclusions: Quinolones prescription to mothers was linked to increased risk of community-acquired quinolone-resistant bacteria in their offspring, by about 50%. This is another example of the deleterious ecological effects of antibiotic use and should be considered when prescribing antibiotics.