Clinical Significance of Extended-spectrum β-lactamase-producing Bacteria in First Pediatric Febrile Urinary Tract Infections and Differences between Age Groups

Abstract

Extended-spectrum β-lactamase-producing bacteria-induced urinary tract infections are increasing and require more potent antibiotics such as carbapenems. We evaluated the clinical significance of extended-spectrum β-lactamase urinary tract infection in children younger than 5 years to select proper antibiotics and determine prognostic factors. Differences were compared between age groups. Methods: We retrospectively studied 288 patients with their first febrile urinary tract infection when they were younger than 5 years. Patients were divided into extended-spectrum β-lactamase-positive and extended-spectrum β-lactamasenegative urinary tract infection groups. Clinical characteristics and outcomes were compared between the groups; an infant group was separately analyzed (onset age younger than 3 months). Results: Extended-spectrum β-lactamase urinary tract infection occurred in 11 % patients who had more frequent previous hospitalization (P=0.02) and higher recurrence rate (P=0.045). During the antimicrobial susceptibility test, the extendedspectrum β-lactamase-positive urinary tract infection group showed resistance to third-generation cephalosporins; however, 98% patients responded clinically. In the infant group, extended-spectrum β-lactamase-positive urinary tract infection occurred in 13% patients and was associated with a longer pre-onset hospitalization history (P=0.002), higher C-reactive protein level (P=0.04), and higher recurrence rate (P=0.02) than that in the older group. Conclusion: Extended-spectrum β-lactamase urinary tract infection requires more attention because of its higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins, but they can be used as first-line empirical antibiotics because of their high clinical response rate. Aminoglycosides can be second-line antibiotics before starting carbapenems when third-generation cephalosporins do not show bactericidal effects for extended-spectrum β-lactamase urinary tract infection.

Antimicrobial Susceptibilities and Laboratory Profiles of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis Isolates as Agents of Urinary Tract Infection in Lebanon: Paving the Way for Better Diagnostics

“…Our study showed a clear correlation between WBC, BUN, creatinine levels and ESBL-producing organisms. However, Park et al showed no significant association [ 43 ], which indicates the need for further studies to clarify this point and to potentially set guidelines for future management.…”

Urinary Tract Infections among Febrile Infants in Qatar: Extended-Spectrum-Beta-Lactamase (ESBL)-Producing Versus Non-ESBL Organisms

“…Notably, the study by Park SY and Kim JH revealed that the mean age of infants in the ESBL group (4.31 months old) was younger than those in the non-ESBL group (6.26 months old). Conversely, Kim YH et al found that the mean age of infants in the ESBL group (4.2 months old) was older than in the non-ESBL group (3.1 months old) [ 21 , 22 ]. Furthermore, Awean GZA et al observed that the majority of infected infants were under 1 year old in both the ESBL group (45.6%) and the non-ESBL group (39.2%) [ 19 ].…”

Clinical Outcomes of Children With Extended-spectrum ß -Lactamase Urinary Tract Infection Receiving Discordant Empiric Antibiotic: A Comparative Study of Fever Duration, Length of Stay, and Readmissions

“…However, the ESBL group was associated with a high recurrence rate (34%), as observed in our study. 14 These discrepant clinical responses and readmission rates may relate to differences in patient population.…”