Pediatr Nephrol DOI 10.1007/s00467-014-2810-y
ORIGINAL ARTICLE
Extended-spectrum β-lactamase-producing bacteria causing community-acquired urinary tract infections in children Orli Megged
Received: 8 January 2014 / Revised: 7 March 2014 / Accepted: 12 March 2014 # IPNA 2014
Abstract Background Extended-spectrum β-lactamase (ESBL)-producing bacteria are infrequent pathogens of communityacquired (CA) urinary tract infections (UTIs) in children. The aim of this study was to assess the frequency of and identify risk factors for CA-UTIs due to ESBL-producing microorganisms (CA-ESBL-UTI). Methods The medical records of all children diagnosed with CA-ESBL-UTI at our medical center between 2003 and 2013 were reviewed. Patients with non-ESBL-UTIs during the same period were included as controls. Results Eighty cases of CA-ESBL-UTI were identified. The incidence of ESBL-UTI increased from 2 to 3.8% during the study period. Compared to children with non-ESBL-UTI, those with ESBL were more likely to be of Arab descent, to have underlying medical conditions, to have received antibiotics in the month prior to the UTI and to have been previously hospitalized. The mean duration of hospitalization for patients with an ESBL-UTI was significantly longer than that for patients with a non-ESBL UTI (3.6 vs. 2 days; P=0.01). In multivariate analysis, Arab ethnicity [odds ratio (OR) 6.1; 95 % confidence interval (CI) 2.7–13.6] and recent antibiotic treatment (OR 4.0; 95 % CI 1.6–10.4) were risk factors for CA-ESBL-UTI. Conclusions The incidence of CA-ESBL-UTI is rising. The empiric treatment for suspected UTI in children who had been previously hospitalized and who had received antibiotics in the last month should cover ESBL-producing bacteria.
O. Megged (*) Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center affiliated with Hebrew University-Hadassah School of Medicine, P.O.B. 3235, Jerusalem, Israel e-mail: [email protected]
Keywords Extended-spectrum β-lactamase . Urinary tract infection . Children . Community-acquired infection
Introduction Urinary tract infection (UTI) is one of the most common bacterial infections in children. Extended-spectrum βlactamases (ESBLs) are enzymes that mediate resistance to some of the β-lactams, including penicillins and cephalosporins. These enzymes hydrolyze extended-spectrum cephalosporins with an oxyimino side chain, but not carbapenems which do not carry this side chain. ESBL-producing bacteria are uncommon pathogens in pediatric UTIs, and current estimations of their prevalence range from
ORIGINAL ARTICLE
Extended-spectrum β-lactamase-producing bacteria causing community-acquired urinary tract infections in children Orli Megged
Received: 8 January 2014 / Revised: 7 March 2014 / Accepted: 12 March 2014 # IPNA 2014
Abstract Background Extended-spectrum β-lactamase (ESBL)-producing bacteria are infrequent pathogens of communityacquired (CA) urinary tract infections (UTIs) in children. The aim of this study was to assess the frequency of and identify risk factors for CA-UTIs due to ESBL-producing microorganisms (CA-ESBL-UTI). Methods The medical records of all children diagnosed with CA-ESBL-UTI at our medical center between 2003 and 2013 were reviewed. Patients with non-ESBL-UTIs during the same period were included as controls. Results Eighty cases of CA-ESBL-UTI were identified. The incidence of ESBL-UTI increased from 2 to 3.8% during the study period. Compared to children with non-ESBL-UTI, those with ESBL were more likely to be of Arab descent, to have underlying medical conditions, to have received antibiotics in the month prior to the UTI and to have been previously hospitalized. The mean duration of hospitalization for patients with an ESBL-UTI was significantly longer than that for patients with a non-ESBL UTI (3.6 vs. 2 days; P=0.01). In multivariate analysis, Arab ethnicity [odds ratio (OR) 6.1; 95 % confidence interval (CI) 2.7–13.6] and recent antibiotic treatment (OR 4.0; 95 % CI 1.6–10.4) were risk factors for CA-ESBL-UTI. Conclusions The incidence of CA-ESBL-UTI is rising. The empiric treatment for suspected UTI in children who had been previously hospitalized and who had received antibiotics in the last month should cover ESBL-producing bacteria.
O. Megged (*) Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center affiliated with Hebrew University-Hadassah School of Medicine, P.O.B. 3235, Jerusalem, Israel e-mail: [email protected]
Keywords Extended-spectrum β-lactamase . Urinary tract infection . Children . Community-acquired infection
Introduction Urinary tract infection (UTI) is one of the most common bacterial infections in children. Extended-spectrum βlactamases (ESBLs) are enzymes that mediate resistance to some of the β-lactams, including penicillins and cephalosporins. These enzymes hydrolyze extended-spectrum cephalosporins with an oxyimino side chain, but not carbapenems which do not carry this side chain. ESBL-producing bacteria are uncommon pathogens in pediatric UTIs, and current estimations of their prevalence range from
