1435. Urinary Tract Infections Due to Extended-Spectrum Β-Lactamase-Producing Bacteria in Hospitalized Children: Demographics, Risk Factors, Clinical Characteristics, Imaging and Treatment

Abstract

BackgroundUrinary tract infections (UTIs) are a common cause for hospitalization in children. Inadequate treatment can lead to long-term renal damage. AAP guidelines recommend third-generation cephalosporins as empiric therapy. However, the incidence of community-acquired multiresistant, extended-spectrum β-lactamase (ESBL)-producing pathogens is rising. More research is needed to evaluate risk factors and management of ESBL UTI in children.MethodsA case–control retrospective study was conducted at a tertiary care children’s hospital from July 2014 to December 2017. Hospitalized, non-ICU patients aged 0–18 years with UTI and urine culture positive for potentially ESBL-producing organisms were retrieved. Of the 1301 cultures reviewed, 106 cases (UTI+ESBL) were identified and 208 controls (UTI+non-ESBL) were randomly selected. We compared demographics, risk factors, clinical characteristics and treatment between both groups.ResultsBoth groups had similar demographics, except for a higher median age for ESBL patients (3 vs. 0 years). ESBL patients were significantly more likely (P < 0.001) to have recent antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities. Both groups had similar clinical presentations and laboratory results. ESBL patients had more VCUGs performed (59.4% vs. 38%), but the prevalence of high-grade VUR was similar in both groups. ESBL patients had longer course of IV antibiotics and length of stay (mean 6 vs. 3 days). Although 59.4% of ESBL patients received inappropriate initial antibiotics based on culture susceptibilities, 77.4% of these patients clinically improved with initial therapy.ConclusionOur results support previous studies demonstrating that prior antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities are risk factors for ESBL UTI. When these are encountered, the suspicion for ESBL should be higher and may guide antibiotic therapy pending culture results. Given the similar prevalence of high-grade VUR in both groups, the presence of ESBL UTI alone should not be an indication to obtain a VCUG. Finally, a subgroup of patients with ESBL UTI might be clinically responsive to third-generation cephalosporins, despite in vitro resistance. Disclosures All authors: No reported disclosures.