Most immunocompromised patients with pulmonary manifestations are treated empirically with multiple medications. Evaluation FOB/BAL is a useful diagnostic tool, and seems to have changed the course of therapy in more than half of patients, by initiation or cessation of treatment. FOB/BAL is a safe diagnostic tool for the evaluation of pulmonary manifestations in this setting.
Purpose
Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) are common pathogens of UTI in children and their prevalence is increasing worldwide. The aim of this study was to determine risk factors for ESBL-positive UTI and susceptibility to antibiotic treatments.
Methods
A retrospective cohort study conducted at Rambam Health Care Campus, a tertiary hospital in northern Israel. The study included patients younger than < 18 years old and ESBL positive UTI between January 2017 and December 2019. Patient demographics, previous antibiotic treatment, previous UTI episode, genitourinary tract abnormalities, identified organisms in urine cultures, and sensitivity to antibiotics were recorded.
Results
A total of 570 children who contributed 639 episodes of community-acquired ESBL UTI with 661 Enterobacteriaceae isolates. The median age was 1.3(IQR:0.69–5.9) years. Female comprised 87.9% of the patients. ESBL isolates were identified in 56 (9.8%) patients. Higher rates of resistance to oral antibiotic treatments were found in the ESBL-positive group compared to the ESBL-negative group; amoxicillin-clavulanic acid (65.2% vs 22.7%, p < 0.001, OR = 6.84), trimethoprim-sulfamethoxazole (59.4% vs 17.6%, p < 0.001, OR = 6.84), ciprofloxacin (34.8% vs 4.5%, p < 0.001, OR = 11.43), and to piperacillin-tazobactam (27.5% vs 6.4%, p < 0.001, OR = 5.54). Neither group was resistant to amikacin or carbapenem. Risk factors for ESBL-positive UTI were antibiotic treatment within the last three months (p = 0.002, OR = 3.68, CI:1.63–8.31) and known ESBL carriage (p < 0.001, OR = 13.18, CI:4.25–40.94).
Conclusions
Known ESBL carriage and recent antibiotic treatment were risk factors for ESBL UTI. High rate of resistance to oral empiric and prophylactic antibiotic treatments was detected. Amikacin as initial treatment in anticipation of culture susceptibility is reasonable.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.