Geographic Distribution of Extended-Spectrum Beta-Lactamase Uropathogens, Social Vulnerability, and Pollution

OBJECTIVE Our objective was to examine spatial patterns of pediatric ESBL uropathogens and investigate the population characteristics and environmental exposures that may contribute to cluster patterns. PATIENTS AND METHODS We screened urine cultures from children < 18 years presenting to a tertiary pediatric emergency department and its affiliated urgent care centers. Cultures yielding ≥50,000 CFU/mL of a single urinary pathogen obtained by catheterization or ≥100,000 CFU/mL obtained by clean catch were included. Cultures with a valid geocoded address were aggregated into census tracts. The primary outcome for this study was the proportion of positive ESBL uropathogens of all the ESBL-capable uropathogens by unit of the census tract. We used Anselin Local Moran’s I statistic to assess spatial clusters and spatial outliers and Kruskal Wallis to compare differences in Social Vulnerability Index (SVI) and CalEnviro Screen (CES) pollution score. RESULTS Of the 6,529 urine cultures included, 251 (3.8%) were ESBL positive. We identified high clusters (n=4, p-value ≤ 0.05) and high outliers (n=10, p-value < 0.05). Census tracts with ESBL uropathogens had higher scores across all themes of social vulnerability and increased pollution exposure. For both SVI and CES, there was a marked difference between no cluster vs low cluster groups (p < 0.001). CONCLUSIONS ESBL uropathogens are not randomly distributed in our community; instead, they are concentrated in specific geographic areas. Census tracts with ESBL uropathogens demonstrated increased social vulnerability and higher pollution burden. The starkest contrast between cluster groups was demonstrated between low cluster and no cluster groups.