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

Abstract

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.

Urinary tract infection caused by extended‐spectrum β‐lactamase‐producing bacteria: Risk factors and antibiotic resistance

“…In the present study there was a high resistance rate (54.%) to gentamycin, in concordance with previous studies . Amikacin resistance was high in the present ESBL cohort, reaching 32%, which is much higher than in other studies that described a resistance of 8% and 2% . We also noted a high resistance rate to nitrofurantoin: 53.2%, which is much higher than in other studies, which ranged from 5 to 25% …”

“…The SMART study from Jordan and Lebanon that looked at Gram‐negative bacilli associated with UTI noted higher resistance to ciprofloxacin, reaching around 74% in E. coli and Klebsiella ESBL isolates . In the present study there was a high resistance rate (54.%) to gentamycin, in concordance with previous studies . Amikacin resistance was high in the present ESBL cohort, reaching 32%, which is much higher than in other studies that described a resistance of 8% and 2% .…”

“…There were no significant differences in the clinical presentation between ESBL‐UTI and non‐ESBL‐UTI, similar to previous studies, apart from longer hospital stay in the ESBL group, as demonstrated in other studies . This can be attributed to limitation in the availability of oral therapy in these patients and delay in initiating the appropriate antimicrobial therapy while waiting on urine culture results.…”

“…Previous use of antibiotics in the last 3 months, previous hospitalization in the last 3 months, history of recurrent UTI, and presence of renal anomalies are important risk factors for acquisition of ESBL‐UTI that should be considered in every child, but on logistic regression analysis only previous hospitalization in the last 3 months was identified as an independent significant risk factor for acquisition of ESBL‐UTI in the present study. This was supported by other studies on the risk factors for acquisition of ESBL‐producing bacteria in children, because previous hospitalization will lead to colonization with ESBL organisms, predisposing them to future UTI. The presence of renal anomalies, previous antibiotic use, and antimicrobial prophylaxis, especially cephalosporin, have all been reported as independent factors for ESBL‐UTI.…”

Bacterial Aetiology and Antibiotic Resistance Pattern of Community-Acquired Urinary Tract Infections in Children in a Tertiary Care Hospital in Bangladesh

“…Moreover, the aetiology of UTI and the pattern of antibiotic resistance have been changing over the past years. 9 Most of the studies on paediatric urinary tract infections caused by multidrug resistant bacteria have been done in western world 10,11 , but these types of studies are scarce in South Asian region. 12 However, there are not much information on aetiology and resistance pattern of community acquired UTIs in Bangladesh.…”