Prevalence, Predictors, and Cross-Resistance of Community-Acquired Extended-Spectrum Beta-Lactamase–Producing Enterobacterales in Pediatric Urinary Tract Infections in Israel

Abstract

This retrospective study evaluates the incidence and risk factors of community-acquired urinary tract infections (CA-UTIs) linked to extended-spectrum beta-lactamase–producing Enterobacterales (ESBLPE). The study was conducted in a tertiary hospital in northern Israel and included children younger than 18 years with CA-UTIs due to Enterobacterales who were admitted to the emergency department, during the years 2017 to 2019. Among the 570 children, 9.8% had ESBLPE-associated CA-UTIs. This prevalence remained steady over the study period. ESBLPE exhibited substantial resistance to amoxicillin/clavulanic acid (62.5% vs 20.4%, P < .001, odds ratio [OR] = 6.5), trimethoprim/sulfamethoxazole (58.9% vs 18%, P < .001, OR = 6.6), ciprofloxacin (33.9% vs 3.1%, P < .001, OR = 15.9), piperacillin/tazobactam (26.8% vs 7%, P < .001, OR = 4.9), and gentamicin (21.4% vs 4.3%, P < .001, OR = 6.1), compared with non-ESBLPE. Risk factors for ESBLPE-associated UTIs included recent antibiotic treatment within the past 3 months ( P = .003, OR = 3.5) and colonization with ESBLPE ( P < .001, OR = 12.8). Given the variable incidence of ESBLPE, relying on local epidemiology for antibiotic selection pending culture results is crucial. The study finding of a low ESBLPE incidence, coupled with global concerns regarding carbapenem resistance, supports cautious use of broad-spectrum antibiotics in nonsevere cases.