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Risk factors for pediatric community-acquired febrile urinary tract infections due to resistant bacteria and
Julie Sarlat1, Lucas Percheron2, Stéphane Decramer3
1Department of Pediatric Nephrology Rheumatology and Internal Medicine, Children's Hospital, Toulouse University Hospital, Toulouse, France.
Insights
Recent hospitalization, prior resistant bacteria infection, and prolonged fever are key risk factors for pediatric febrile urinary tract infections (FUTI) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE). Early identification aids in better patient management.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- Febrile urinary tract infections (FUTI) are common in children.
- Increasing global prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in FUTI cases.
- Need to identify risk factors for community-acquired FUTI caused by ESBLE in pediatric populations.
Purpose of the Study:
- To determine significant risk factors for community-acquired FUTI caused by ESBLE in children.
- To analyze therapeutic strategies and their effectiveness for ESBLE-mediated FUTI.
Main Methods:
- Retrospective case-control study at a single center.
- Inclusion of children hospitalized for FUTI between 2016 and 2020.
- Matching ESBLE-mediated FUTI cases with non-ESBLE-mediated FUTI controls (1:3 ratio).
Main Results:
- Significant risk factors identified include recent antibiotic therapy, recent hospitalization, prior ICU stay, recurrent FUTI, travel to endemic areas, history of resistant infections, congenital anomalies of the kidney and urinary tract (CAKUT), antibiotic prophylaxis, and duration of fever.
- Independent risk factors in multivariate analysis were hospitalization within 3 months (ORa 3.6), history of resistant bacterial infection (ORa 20.9), and number of days with fever (ORa 1.3).
Conclusions:
- Identifying specific risk factors for ESBLE-related FUTI in children is crucial.
- This knowledge can lead to improved patient management strategies and targeted interventions.
Background:
Febrile urinary tract infection (FUTI) is one of the most common bacterial infections in children. Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) involved in these infections are increasing worldwide. The aim of this study is to establish risk factors (RFs) for developing community-acquired FUTI due to ESBLE in children. The secondary objectives are to analyze therapeutic options used in probabilistic and definitive treatments and their efficacy.
Methods:
In this single-center, retrospective, case-control study conducted at Toulouse Children's Hospital between 1st January 2016 and 31 December 2020, we identified all children hospitalized for FUTI. ESBLE-mediated FUTI was the case group. The control group comprising non-ESBLE-mediated FUTIs was randomly selected and matched according to age and year of diagnosis with a ratio of 1 case for 3 controls.
Results:
264 children were enrolled, 66 in the ESBLE-mediated FUTIs group and 198 in the non-ESBLE-mediated FUTIs group. RFs found to be significant were antibiotic therapy in the previous 3 months (p 0.0018); hospitalization in the previous 3 months (p<0.001); hospitalization in an intensive care unit in the previous 3 months (p<0.016); recurrence of FUTI whatever the delay (p 0.042); travel to a highly endemic area in the previous 3 months (p 0.003); a history of infection due to resistant bacteria (p<0.001); CAKUT (p 0.018); antibiotic prophylaxis (p 0.045); the number of days presenting fever prior to diagnosis (p 0.03). In multivariate analysis, the independent RFs were: hospitalization in the previous 3 months (ORa 3.6 [1.9-6.9]), history of infection due to resistant bacteria (ORa 20.9 [5-311]) and the number of days presenting fever prior to diagnosis (ORa 1.3 [1.1-1.6]).
Conclusion:
Identifying risk factors for developing community-acquired FUTI due to ESBLE may allow for better management of patients.
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