Objective To assess the exposure levels of antibiotics in the urine of school-age children, and to identify influencing factors, in order to provide evidence for the prevention and control of antibiotics exposure in children. Methods A total of 820 children aged 6 - 9 years were recruited from 8 urban and 4 suburban/rural schools in Qufu City and 6 urban and 3 suburban/rural schools in Zhongshan City between October and December 2019. Data on demographic and socioeconomic characteristics, dietary habits, and urinary antibiotic concentrations were collected. The detection of antibiotics in urine was used as the outcome, and binary logistic regression was employed to analyze influencing factors. Results The detection rates of antibiotics in the urine of the 820 school-age children were as follows: human antibiotics (HAs) 63.0%, veterinary antibiotics (VAs) 34.3%, antibiotics primarily used in humans but also shared with animals (PHAs) 46.3%, antibiotics primarily used in animals but also shared with humans (PVAs) 61.3%, combined HAs and PHAs (HAs_PHAs) 76.5%, combined VAs and PVAs (VAs_PVAs) 70.5%, and the total detection rate of 32 antibiotics was 92.9%. Univariate logistic regression revealed that older children had a lower detection rate of HAs (OR=0.744). Children from northern regions had higher detection rates of HAs, PHAs, HAs_PHAs, and total antibiotics compared to those from southern regions (OR=2.494, 6.930, 5.250, 4.757). Urban children had a higher detection rate of VAs than suburban/rural children (OR=1.703). Children with higher parental education levels had lower detection rates of PHAs and HAs_PHAs (OR=0.314, 0.627). Children from households with higher monthly incomes had lower detection rates of PHAs, HAs_PHAs, and total antibiotics (OR=0.386, 0.572, 0.400). Multivariate logistic regression analysis indicated that low fruit consumption frequency (0 - 3 times/week)was a risk factor for HAs and HAs_PHAs exposure (OR=1.384, 1.491), while high fruit consumption frequency (>8 times/week) was a risk factor for VAs exposure (OR=1.784). High poultry consumption frequency (≥4 times/week) was a risk factor for PVAs exposure (OR=1.466), and high soft drink consumption frequency (at least once a week) was a risk factor for VAs_PVAs and total antibiotic exposure (OR=1.394, 1.816). Conclusions School-age children in Zhongshan City, Guangdong Province, and Qufu City, Shandong Province, are widely exposed to antibiotics. Factors such as age, household monthly income, parental education level, urban-rural differences, north-south regional differences, and specific dietary habits influence antibiotic exposure in this population.
Key words
school-age children /
antibiotics /
diet /
soft drink /
exposure
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