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Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns
Woosuck Suh1, Bi Na Kim1, Hyun Mi Kang1
1Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
Febrile urinary tract infections (fUTI) are most common in infants under 12 months. Rising multidrug-resistant and extended-spectrum beta-lactamase (ESBL) producing bacteria necessitate updated treatment guidelines for children with VUR.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Understanding febrile urinary tract infection (fUTI) epidemiology in children is crucial for risk stratification and diagnosis.
- Early diagnosis and treatment of fUTI are essential for preventing complications.
Purpose of the Study:
- To analyze the epidemiology and etiology of first-time fUTI in children.
- To investigate changes in antibiotic susceptibility patterns for pediatric fUTI.
Main Methods:
- Retrospective observational cohort study of children under 19 years with their first fUTI (2006-2016).
- Analysis of electronic medical records and radiologic images.
Main Results:
- fUTI predominantly affected children under 12 months (78.0%).
- Escherichia coli was the most common pathogen (83.8%).
- Significant increases in multidrug-resistant and ESBL-producing strains were observed annually.
- Recurrence rates were higher for ESBL-producing organism fUTI in patients with VUR (75.0% vs. 30.0%).
Conclusions:
- fUTI prevalence is highest in infants, with female predominance after 12 months.
- Increasing prevalence of ESBL producers requires attention.
- Carbapenems are recommended over noncarbapenems for ESBL-producing gram-negative rod fUTI in children with VUR to reduce recurrence.
Background:
Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment.
Purpose:
This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children.
Methods:
This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated.
Results:
A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03).
Conclusion:
fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.
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