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Extended-Spectrum Beta-Lactamase Positivity in Infants with Febrile Urinary Tract Infection: Risk Factors, Pathogen

Serap Ata1, Sevgi Akova2

  • 1Department of Pediatrics, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye.

Turkish Archives of Pediatrics
|April 27, 2026
PubMed

Insights

Urinary tract anomalies and prior antibiotic exposure increase the risk of extended-spectrum beta-lactamase (ESBL) producing bacteria in infants with febrile urinary tract infections (UTIs). Klebsiella pneumoniae is increasingly prevalent, necessitating a review of empirical antibiotic strategies.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Febrile urinary tract infections (UTIs) in infants are a common concern.
  • Extended-spectrum beta-lactamase (ESBL) producing organisms pose a significant treatment challenge.
  • Understanding risk factors and trends is crucial for effective management.

Purpose of the Study:

  • Identify risk factors for ESBL positivity in infants with febrile UTI.
  • Compare pathogen distribution and antibiotic resistance based on ESBL status.
  • Analyze temporal trends in ESBL positivity and associated pathogens.

Main Methods:

  • Retrospective, single-center study of 321 infants (1-12 months) with first febrile UTI.
  • Comparison of ESBL-positive and ESBL-negative bacterial isolates.
  • Analysis of temporal trends in ESBL positivity, pathogens, and empirical antibiotic use.

Main Results:

  • Overall ESBL positivity rate was 57.3%.
  • Risk factors included urinary tract anomalies, recent antibiotic exposure, and prophylactic antibiotic use.
  • Klebsiella pneumoniae and Enterobacter cloacae were more frequent in ESBL-positive isolates, while Escherichia coli was less frequent.
  • Higher resistance rates to common antibiotics were observed in ESBL-positive isolates.
  • ESBL positivity peaked in 2023, with decreasing E. coli and increasing K. pneumoniae frequencies over time.

Conclusions:

  • Urinary tract anomalies and prior antibiotic exposure are key risk factors for ESBL-positive febrile UTI in infants.
  • The rising prevalence of K. pneumoniae and high resistance rates necessitate reassessment of empirical antibiotic strategies.
  • This highlights the need for vigilant monitoring and adaptive treatment approaches in pediatric populations.
Abstract

Keywords:
EnterobacteriaceaeTürkiyeantimicrobial resistanceextended-spectrum beta-lactamaseinfantrisk factorsurinary tract infections

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