Geographic distribution of extended spectrum beta-lactamase (ESBL) uropathogens and social vulnerability and pollution

Abstract Background Children are vulnerable to poor health outcomes from pollution exposure and pollution can adversely affect urinary health. Geospatial analysis has demonstrated extended spectrum beta-lactamase (ESBL) uropathogen clusters at a community level, and further analysis has the potential identify any associated geographic, social vulnerability, or environmental risk factors.Methods Urine cultures, from children aged < 18 years from January 1, 2013, to December 31, 2018, obtained from a tertiary pediatric emergency department and its affiliated urgent care center were screened for inclusion. Urine 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. Social vulnerability index and pollution indicators were used to characterize locations with and without clustering.Results Of the 6,529-culture confirmed UTIs, 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) within metro and rural eastern San Diego County. Census tracts with ESBL uropathogens had higher scores across all themes of social vulnerability and had increased pollution exposure.Conclusions ESBL uropathogens exist in distinct clusters within San Diego County and the census tracts with ESBL uropathogens demonstrate increased social vulnerability and experience greater air pollution. This study is limited by specific patient-level analysis.