Urinary Tract Infections With Extended-spectrum-β-lactamase-producing Bacteria: Case-control Study

Area of Science:

• Pediatric Infectious Diseases
• Clinical Microbiology
• Antimicrobial Resistance

Background:

• Urinary tract infections (UTIs) are common in young children, with extended-spectrum beta-lactamases (ESBLs) increasingly identified as a cause.
• Data on risk factors and clinical features of pediatric ESBL-UTIs remain limited.

Purpose of the Study:

• To identify predisposing risk factors, clinical, and microbiological features of pediatric UTIs caused by ESBL-producing bacteria (ESBL-PB).

Main Methods:

• A nested case-control study compared 240 pediatric patients with ESBL-PB UTI to 480 controls with non-ESBL-PB UTI.
• Patients were matched for age and year of diagnosis, with data collected between January 1, 2012, and December 31, 2016.

Main Results:

• Independent risk factors for ESBL-PB UTI included cystostomy (OR 3.7) and underlying comorbidities (OR 2.4).
• Patients with ESBL-PB UTI had higher rates of prior ICU admission, comorbidities, hospitalizations, and cephalosporin exposure.
• Hypothermia was more common in ESBL-PB UTI cases, which also had longer hospital stays and increased ICU admission likelihood.

Conclusions:

• Children with comorbidities and cystostomy are at increased risk for ESBL-PB UTI, though many cases lack identifiable risk factors.
• Clinical signs and biochemical markers are unreliable for differentiating ESBL-PB from non-ESBL-PB UTIs.
• Further research is needed to guide empirical therapy and antimicrobial use strategies for pediatric ESBL-PB UTIs.