Childhood urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and empiric therapy

Pediatr Int. 2017 Feb;59(2):176-180. doi: 10.1111/ped.13112. Epub 2016 Oct 19.

Abstract

Background: This study investigated risk factors of childhood urinary tract infection (UTI) associated with extended-spectrum β-lactamase (ESBL)-producing bacteria (ESBL-positive UTI) and evaluated antimicrobial resistance as well as empiric treatment of childhood UTI.

Methods: The records of children with positive urine culture between 1 January 2008 and 31 December 2012 were evaluated. Patients with positive urine culture for ESBL-producing bacteria were defined as the ESBL-positive group, whereas patients of the same gender and similar age with positive urine culture for non-ESBL-producing bacteria were defined as the ESBL-negative group. Each ESBL-positive patient was matched with two ESBL-negative patients.

Results: The ESBL-positive and negative groups consisted of 154 and 308 patients, respectively. Potential risk factors for ESBL-positive UTI were identified as presence of underlying disease, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months (P < 0.05). On logistic regression analysis, CIC, hospitalization and history of infection in the last 3 months were identified as independent risk factors. In the present study, 324 of 462 patients had empiric therapy. Empiric therapy was inappropriate in 90.3% of the ESBL-positive group and in 4.5% of the ESBL-negative group. Resistance to nitrofurantoin was similar between groups (5.1% vs 1.2%, P = 0.072); resistance to amikacin was low in the ESBL-positive group (2.6%) and there was no resistance in the ESBL-negative group.

Conclusions: Clean intermittent catheterization, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL-positive UTI. The combination of ampicillin plus amikacin should be taken into consideration for empiric therapy in patients with acute pyelonephritis who have the risk factors for ESBL-positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis.

Keywords: child; extended-spectrum β-lactamase; risk factor; treatment; urinary tract infection.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Escherichia coli Infections / diagnosis
  • Escherichia coli Infections / drug therapy
  • Escherichia coli Infections / etiology
  • Escherichia coli Infections / microbiology*
  • Female
  • Humans
  • Klebsiella Infections / diagnosis
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / etiology
  • Klebsiella Infections / microbiology*
  • Logistic Models
  • Male
  • Microbial Sensitivity Tests
  • Retrospective Studies
  • Risk Factors
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / microbiology*
  • beta-Lactam Resistance*

Substances

  • Anti-Bacterial Agents