Nam Hyo Kim; Ji Hee Kim; Taek Jin Lee

doi:10.3947/ic.2009.41.6.333

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Kim, Kim, and Lee: Risk Factors for Community-onset Urinary Tract Infections due to Extended-spectrum β-lactamase Producing Bacteria in Children

Orginal Article

Infect Chemother 2009;41(6):333-341.

Published online: 31 December 2009

DOI: https://doi.org/10.3947/ic.2009.41.6.333

Risk Factors for Community-onset Urinary Tract Infections due to Extended-spectrum β-lactamase Producing Bacteria in Children

Nam Hyo Kim, Ji Hee Kim, Taek Jin Lee

Department of Pediatrics, CHA Bundang Medical Center, CHA University, Korea

Corresponding author : Taek Jin Lee, M.D. Department of Pediatrics, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, Korea Tel : +82-31-780-5230, Fax : +82-31-780-5239 E-mail : bjloveu@lycos.co.kr

Received 4 August 2009 Accepted 23 October 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Extended-spectrum β-lactamase (ESBL) producing bacteria have been increasingly recognized in the community. The aim of this study was to identify risk factors for community-onset urinary tract infections (UTIs) by ESBL producers in children.

Materials and Methods

We analyzed 854 episodes of community-onset UTIs in children diagnosed at CHA Bundang Medical Center from January, 2004 to April, 2009. The presence of ESBL in Escherichia coli and Klebsiella spp. was screened and confirmed by VITEK^®-2 ESBL test. Controls were matched in a 2:1 ratio to case patients by age and sex. The clinical characteristics, risk factors, antimicrobial resistance, and treatment efficacy were compared with controls.

Results

The most common pathogen was Escherichia coli (681 isolates), followed by Klebsiella pneumoniae (60 isolates), Enterococcus faecalis (23 isolates), etc. The number of isolated ESBL producers among the pathogens E. coli and K. pneumoniae was 25 (3.7%) and 7 isolates (11.7%), respectively. No significant differences were noted as to the UTI history prior to the present treatment, underlying urogenital anomaly, and clinical characteristics. Use of any antibiotics within a month (P=0.012, Odds ratio, 6.341, 95% confidence interval, 1.492 to 26.955) was related to the increased risk of community-onset UTI by ESBL producers.

Conclusions

ESBL-producing bacteria has been identified in pediatric community-onset UTI, and the use of any antibiotics within the previous month was related to the increased risk of UTI by ESBL producers. Therefore, careful selection and use of antibiotics should be recommended for community-onset UTI in children.

Keywords: Extended-spectrum β-lactamase, Urinary tract infection, Children

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Table 1.

Causative Organisms Isolated from Patients with Community-onset Urinary Tract Infections

Pathogen	No. of isolated (%)
Gram-negative organisms
Escherichia coli	681 (79.7)
Klebsiella pneumoniae	60 (7.0)
Klebsiella oxytoca	3 (0.4)
Klebsiella species	1 (0.1)
Enterobacter cloacae	13 (1.5)
Enterobacter aerogenes	16 (1.9)
Enterobacter species	5 (0.6)
Citrobacter freundii	15 (1.8)
Pseudomonas aerusinosa	3 (0.4)
Burkholderia cepacia	2 (0.3)
Morganella morganii	3 (0.4)
Proteus mirabiiis	3 (0.4)
Subtotal	805 (94.3)
Gram-positive organisms
Enterococcus faecalis	23 (2.7)
Enterococcus faecium	7 (0.8)
Enterococcus casseliflavus	1 (0.1)
Enterococcus species	6 (0.7)
Staphylococcus aureus	8 (0.9)
α-streptococci	1 (0.1)
β-hemolytic streptococcus group B	2 (0.2)
Coagulase negative staphylococcus	1 (0.1)
Subtotal	49 (5.7)
Total	854 (100)

Table 2.

Clinical Characteristics of Patients of Community-onset Urinary Tract Infections by Either Extended-spectrum β-lactamase-producing Organisms or Extended-spectrum β-lactamase Non-producing Organisms

	ESBL (n=32)	non-ESBL (n=66)	p-value
Male (%)	50.0	56.1	0.572
Mean age (months)	10.0±16.2	12.7±18.1	0.486
Hospitalization (days)	6.8±3.5	6.3±1.9	0.427
Duration of fever (days)	27±4.2	1.9±1.6	0.283

Abbreviation ： ESBL, extended-spectrum β-lactamase

Table 3.

Basic Analysis of Potential Risk Factors for Community-onset Urinary Tract Infections by Either Extended-spectrum β-lactamase-producing or Extended-spectrum β-lactamase Non-producing Organisms

	ESBL (n=32)	non-ESBL (n=66)	p-value	Odds ratio (95% Confidential Interval)
Use of any antibiotics within previous 1 month	9 (28.1%)	3 (4.5%)	0.001	6.188 (1.797-21.308)
UTI history before this treatment	7 (21.9%)	4 (6.1%)	0.020	3.609 (1.139-11.441)
Underlying urogenital anomaly^*	6 (27.3%)	8 (13.1%)	0.128
Vesicoureteral reflux	6	5
Ureteropelvic junction obstruction	0	1
Kidney agenesis	0	1
Duplex kidney	0	1

^* Patients with unidentified underlying disease excluded from data. Missing cases are 10 cases in the ESBL group, and 5 cases in the non-ESBL group.

Abbreviations : ESBL, extended-spectrum β-lactamase; UTI, urinary tract infection

Table 4.

Antibiotic Resistance (%) of Extended-spectrum β-lactamase-producing Organisms and Extended-spectrum β-lactamase Non-producing Organisms

	ESBL (n=32)	non-ESBL (n=66)	P-value
Ampicillin	93.8%	77.3%	0.043
Amoxicillin/clavulanic acid	62.5%	21.2%	<0.001
Aztreonam	18.8%	0%	<0.001
Cefazolin	87.5%	66.7%	0.028
Cefoxitin	3.1%	7.6%	0.389
Ceftriaxone	28.1%	0%	<0.001
Cefepime	12.5%	0%	0.003
Ciprofloxacin	34.4%	6.1%	<0.001
Gentamicin	25.0%	21.2%	0.673
Tobramycin	34.4%	7.6%	0.001
Amikacin	6.3%	0%	0.040
Imipenem	0%	0%
丁 rimethoprim/sulfamethoxazole	40.6%	22.7%	0.066
Piperacillin	28.1%	3.0%	<0.001
Piperacillin/tazobactam	25.0%	0%	<0.001

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