Abstract
The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae urinary tract infections (UTIs) is increasing worldwide. We investigated the prevalence, clinical findings, impact and risk factors of ESBL E. coli/K. pneumoniae UTI through a retrospective review of the medical records of children with UTI aged <15 years admitted to Prince of Songkla University Hospital, Thailand over 10 years (2004-2013). Thirty-seven boys and 46 girls had ESBL-positive isolates in 102 UTI episodes, compared with 85 boys and 103 girls with non-ESBL isolates in 222 UTI episodes. The age of presentation and gender were not significantly different between the two groups. The prevalence of ESBL rose between 2004 and 2008 before plateauing at around 30-40% per year, with a significant difference between first and recurrent UTI episodes of 27.3% and 46.5%, respectively (P = 0.003). Fever prior to UTI diagnosis was found in 78.4% of episodes in the non-ESBL group and 61.8% of episodes in the ESBL group (P = 0.003). Multivariate analysis indicated that children without fever (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.23-3.74) and those with recurrent UTI (OR 2.67, 95% CI 1.37-5.19) were more likely to yield ESBL on culture. Congenital anomalies of the kidney and urinary tract were not linked to the presence of ESBL UTI. In conclusion, ESBL producers represented one-third of E. coli/K. pneumoniae UTI episodes but neither clinical condition nor imaging studies were predictive of ESBL infections. Recurrent UTI was the sole independent risk factor identified.
Highlights
Escherichia coli and Klebsiella pneumoniae are the two most common causative organisms of urinary tract infection (UTI) in childhood [1, 2]
Of 336 children diagnosed with 429 UTI episodes during the study period, E. coli and K. pneumoniae were causative in 271 children (80.7%) and 324 episodes (75.5%)
UTI were significantly more likely to have an extendedspectrum beta-lactamase (ESBL) producer as a causative agent. Our study in this group of Thai children with UTI showed that the prevalence of ESBL-producing E. coli/K. pneumoniae increased in the decade between 2004 and 2013 but has remained steady at around 30–40% to the time of this study in 2020
Summary
Escherichia coli and Klebsiella pneumoniae are the two most common causative organisms of urinary tract infection (UTI) in childhood [1, 2]. Both species frequently produce extendedspectrum beta-lactamase (ESBL) enzymes which confer resistance to beta-lactam antibiotics including third- and fourth-generation cephalosporins, and monobactams [3, 4]. Appropriate empirical antibiotics should be prescribed immediately on the presentation of a suspected UTI before susceptibility results are available but most empirical regimens lack activity against ESBL-positive isolates. The majority of ESBL diagnoses and treatments are often delayed subject to antimicrobial susceptibility data
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