Extended - spectrum beta - lactamase E. coli and K. pneumoniae urinary tract infections

Abstract

Background: The prevalences of extended - spectrum beta - lactamase (ESBL) Escherichia coli ( E . coli ) and Klebsiella pneumoniae ( K . pneumoniae ) urinary tract infections (UTI) in children are increasing worldwide. We aimed to investigate the prevalence, clinical findings, impact and risk factors of ESBL E . coli / K . pneumoniae UTI.Methods: The medical records of children with UTI aged <15 years admitted to Prince of Songkla University Hospital were reviewed. Results: Theirty-seven boys and 46 girls had ESBL in 102 UTI episodes; 85 boys and 103 girls had non-ESBL in all of their 222 UTI episodes. The median age at presentation was 1.5 (0.7 - 4.8) years for the ESBL group and 1.3 (0.6 - 3.9) for the non-ESBL group (p=0.2). Age and gender were not significantly different between the two groups. The prevalence of ESBL rose between 2004 and 2008 before plateauing at around 30-40% per year. The prevalences in first and recurrent UTI were 27.3% and 46.5%, respectively (p=0.003). Fever prior to UTI diagnosis was found in 78.4% of episodes in the non-ESBL group and 61.8% of episodes in the ESBL group (p=0.003). Multivariate analysis, children without fever (OR=2.14, 95% CI: 1.23-3.74) and those with recurrent UTI (OR=2.67, 95% CI: 1.37 – 5.19) were more likely to have ESBL UTI. The presence of CAKUT had no effect on ESBL UTI. Conclusions: ESBL was found in one-third of E . coli / K . pneumoniae UTI episodes. No clinical condition nor imaging study could predict ESBL. Recurrent UTI was the only independent risk factor.

Urinary Tract Infection (UTI) caused by Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae: a case series

“…They have varying antimicrobial resistance mechanisms that may include the production of extended-spectrum b-lactamase (ESBL). 11, 12 Escherichia coli and Klebsiella species are found in specific genera of the Enterobacteriaceae family, including Escherichia coli and Klebsiella pneumoniae and other bacteria such as Haemophilus influenzae and Pseudomonas aeruginosa. 4 Our study shows that women are more susceptible to UTI than men due to the differences in the anatomy in both eliminatory and reproductive systems.…”

“…Childhood UTIs may cause increased morbidity, hospitalization and long-term clinical consequences like renal scars, hypertension and chronic kidney damage. 6, 12 As ESBL infections have been reported increasingly worldwide. This condition makes us have to be aware of the possibility of ESBL transmission in our hospital.…”