Risk Factors for Community-Aquired Urinary Tract Infection with ESBL-Producing Bacteria in Children
Pediatrics International,

Kizilca O et al. – Recognition of the risk factors for extended–spectrum beta–lactamases [ESBL]–producing bacteria may be helpful to determine new policies in management of urinary tract infection. These results suggest that recurrence of UTI should be prevented especially in the first year of life and prophylactic use of cephalosporins should be avoided.

Methods
  • 344 patients diagnosed as urinary tract infection between January 2008 and December 2009 were enrolled in this retrospective study.
  • Causative microorganisms were ESBL-producing in 148 patients and non–ESBL-producing in 196 patients.
  • There was no difference between the two groups regarding distribution of age, sex and follow up duration.

Results
  • The most frequent causative agents were E. coli of which 41.4 % were ESBL producing.
  • Among Klebsiella species, 53.2% were ESBL-producing.
  • The resistance rates in ESBL-producing bacteria were 83.1% for trimethoprim/sulfamethoxazole, 18.2% for nitrofurantoin, 47.3% for quinolones, 39.9% for aminoglycosides.
  • In non–ESBL-producing bacteria, the resistance rates were 62.2% for trimethoprim/sulfamethoxazole, 4.6% for nitrofurantoin, 9.7% for quinolones, 9.7% for aminoglycosides.
  • Age below 1 year, high recurrence rate of UTI, long duration of prophylaxis, using cephalosporins for prophylaxis, having been hospitalized in the past 3 months and clean intermittent catheterisation were found to be significant risk factors for ESBL poducing bacteria [p<0.05].
  • Logistic regression analysis identified age below 1 year and high recurrence rate of UTI to be independent risk factors increasing the risk 1.74 fold and 2.25 fold respectively.

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