Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriaceae in community-acquired urinary tract infections in children and susceptibility to commonly used antibiotic treatments

Abstract

Abstract 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.