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Emergence of Extended-Spectrum β-Lactamase-Producing Pathogens in Community-Acquired Urinary Tract Infections Among
Vanessa Tamas1, Seema Shah, Kathryn A Hollenbach
1From the Department of Pediatrics, University of California San Diego School of Medicine, La Jolla; and Rady Children's Hospital San Diego, San Diego, CA.
Insights
Extended-spectrum β-lactamase (ESBL)-producing organisms are an increasing cause of infant urinary tract infections (UTIs). Outpatient management may be suitable for infants over two months old, but hospitalization is more likely for younger infants or those with prior NICU stays.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Pediatrics
Background:
- Extended-spectrum β-lactamase (ESBL)-producing pathogens are prevalent in adult hospitalizations.
- Urinary tract infections (UTIs) in children are linked to risk factors like urinary tract abnormalities.
- The characteristics of ESBL-producing organism UTIs in infants remain under-explored.
Purpose of the Study:
- To determine the incidence of UTIs caused by ESBL-producing organisms in infants.
- To describe the clinical management of these infant UTIs in a pediatric emergency department.
- To identify risk factors associated with hospitalization for these infections.
Main Methods:
- Retrospective review of infant cases with positive urinalysis and ESBL-producing organism urine cultures (2013-2017).
- Data abstraction included clinical management and risk factors like prior NICU stay and urologic abnormalities.
- Analysis compared characteristics of hospitalized versus discharged patients.
Main Results:
- Forty-five ESBL-producing organism UTIs occurred in 43 infants; ESBL Escherichia coli was most common.
- Incidence ranged from 0.9% to 4.5% over the study period.
- Younger infants (1.9 vs 6.7 months) and those with prior NICU stays were more likely to be admitted.
Conclusions:
- ESBL-producing organisms are a growing cause of infant UTIs presenting to pediatric emergency departments.
- Outpatient management appears feasible for infants older than two months.
- Younger infants and those with specific risk factors warrant closer monitoring and consideration for admission.
Background:
Extended-spectrum β-lactamase (ESBL)-producing pathogens are common among adults and are associated with extended and multiple hospitalizations. They cause urinary tract infections (UTIs) among children with known risk factors such as urinary tract abnormalities and antimicrobial prophylaxis. The emergence of UTIs caused by ESBL-producing organisms among infants has not been well characterized.
Objective:
We sought to describe the incidence and current clinical management of infants who were diagnosed with UTIs caused by ESBL-producing organisms at a pediatric emergency department (ED). In addition, we sought to describe risk factors associated with inpatient hospitalization for UTIs caused by ESBL-producing organisms.
Methods:
We retrospectively identified infants who were treated in the ED from 2013 to 2017 and who had positive urinalyses and urine cultures positive for greater than 50,000 colony-forming unit per milliliter of a single ESBL-producing urinary pathogen. We abstracted details of clinical management and known previous risk factors, including prior neonatal intensive care unit hospitalization stay, prior UTI caused by an ESBL-producing organism, and known urologic abnormalities.
Results:
Forty-five UTIs caused by ESBL-producing organisms occurred in 43 patients (mean age of 5.9 months and 59% female)-ESBL Escherichia coli represented the majority (42/45). The incidence of UTIs caused by ESBL-producing organisms ranged from 0.9% to 4.5% during the 5-year study period. The 13 patients (26%) admitted from the ED were significantly younger than discharged patients (1.9 vs 6.7 months, P = 0.016) and more likely to have had prior neonatal intensive care unit hospitalizations (50% vs 15.6%, P = 0.0456). Of the 33 visits (77%) resulting in initial outpatient management, 5 were followed by readmission for parenteral antibiotic treatment. Of those who were readmitted, 40% (n = 2) were afebrile at the time of admission. The remainder (28/33) completed outpatient oral antibiotic courses guided by susceptibilities. Two patients (4%) had negative repeat urine cultures despite in vitro resistance to initial antibiotic coverage.
Conclusions:
Extended spectrum β-lactamase-producing organisms are an increasing cause of UTIs in infants presenting at a pediatric ED, and outpatient management may be reasonable for infants older than 2 months.
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