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M.D., kim, cho, Tchah, jeon, Ryoo, and Sun: Febrile Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum B-Lactamase-Producing and-Nonprducing Bacteria: A Comparative study
Original Article

Pediatr Infect Vaccine 2015;22(1):29-35.

Published online: 21 January 2015

DOI: https://doi.org/10.14776/piv.2015.22.1.29

Febrile Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum B-Lactamase-Producing and-Nonprducing Bacteria: A Comparative study

Do Hee Ahn M.D., Kyu Won kim, M.D., Hye-Kyung cho, M.D., Han Tchah, M.D., In sang jeon, M.D., Eell Ryoo, M.D., Yong Han Sun, M.D.

Department of pediatrics, Graduate school of medicine, University, Incheon, Korea

Received 7 October 201428 October 2014       Accepted 28 October 2014

Copyright © 2015 The Korean Society of Pediatric Infectious Diseases

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to investigate the clinical characteristics and outcome of febrile urinary tract infections (UTIs) caused by community-acquired extended-spectrum B-lactamase (CA-ESBL)-producing and -nonpr0ducing bacteria. Methods: We analyzed febrile UTls in children hospitalized at Gachon University Gil Medical Center from January 2011 to December 2013 through retrospective data collection from their medical records.

Results

Among pathogens causing 374 episodes of UTIs, the proportion of ESBL-producing bacteria was 13.1% (49/374). The proportion of ESBL—producing Escher/ch/a (0/7 and K/ebs/efla spp. was 13.6% (48/354) and 5.0% (1/20), respectively. There was no significant difference between the CA-ESBL and CA non-ESBL groups in duration of fever (4212.7 vs.3.7:2.1 days, P=0.10) and bacterial eradication rate with empirical antibiotics (100% vs. 100%). The risk of cortical defects on renal scan significantly depended on existence of vesicoureteral reflux rather than ESBL production of pathogen.

Conclusions

There was no significant difference between the CA-ESBL and CA non-ESBL groups in renal cortical defects and clinical outcome. Careful choice of antibiotics is important for treatment of community-acquired UTI in children.

Keywords: Urinary tract infection, Extended-spectrum B-Iactamase

REFERENCES

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Table 1.
Demographic and Clinical Characteristics of Febrile Urinary Tract Infections Caused by CA— ESBL—Producing and -Nonproducing Bacteria
Date ESBL (+) (n=49) ESBL (-) (n=325) Pvalue
Demographic factors
  Sex (MzF) 1.5:1 1.6:1  
  Male 29 (59.2%) 198 (60.9%) 0.94∗
  Female 20 (40.8%) 127 (39.1%)  
Age, in Mo
Median (interquartile) 6 (4-10) 4 (3-7) 0.18†
Year
  2011 14 (10.4%) 121 (89.6%)  
  2012 14 (12.8%) 95 (87.2%)  
  2013 21 (16.2%) 109 (83.8%)  
Clinical characteristics and outcomes
  Creatinine, mg/dL      
  Median (interquartile) 0.2 (0.2-0.3) 0.2 (0.2-0.3) 0.12†
  White blood cell count,/ mm3      
  Median (interquartile) 14,180 (10210-16880) 15,130 (11,470-18,440) 0.64‘
  C—reactive protein, mq/dL      
  Median (interquartile) 3.9 (1.9-5.6) 3.9 (2.1-7.6) 0.17†
Pathogens
  E.coli 48 306  
  Klebsiella spp 1 1Q  
  Time to defervescence after the initiation of antibiotic therapy (days) 2.1±1.3 2,1±1.1 0.21†
  Duration of fever (days) 4.2±2.7 3.7±2.1 0.10†
  Cortical defect on DMSA scan 1/31(3.2%) 19/218(8 7%) 0 48∗
  Urosepsis 0 (0%) 6 (1.8%) 0.73∗
  Recurrence during the study period 2 (4.1%) 9 (2.8%) 0.96∗
Risk factors
  Vesicoureteral reflux 7 (14.3%) 29 (8.9%) 035∗
  Urinary tract anomalies 7 (14.3%) 32 (9.8%) 0.49∗
  Underlying diseases 1 (1.0%) 8 (1.5%) 0. 75∗
  Recent hospitalization 8 (16.3%) 42 (12.9%) 0.67∗
  Previous NICU/ICU admission 2 (4.1%) 23 (7.1%) 063∗
  Previous UTI 6 (12.2%) 19 (5.8%) 0.27∗

∗ By the Chi-square test.

† t -test.

Abbreviation: CA-ESB. Commiunity-acquited extended-spectrum B-lactamase.

Table 2.
Antibiotic Resistance of CA-ESBL Producing an Nonnroducinq Bacteria in Febrile Urinarv Tract infections
Data ESBL (+) (N=49) ESBL (-) (N=325) p value∗
Amoxicillin/clavulanic acid 9 (18.4%) 18 (5.5%) <0.05
Amikacin 0 (0%) 1 (0.3%) 0.27
Ciorofloxacin 10 (20.4%) 26 (8.0%) <0.05
Gentamicin 18(36.7%) 40(17 3%) <0 0'3
Imipenem 0 (0%) 0 (0%) -
Pioeracillin/tazobactam 1 (2.0%) 3 (4.0%) 0.79
Tetracycline 18 (36.7%) 62 (19.1%) <0.05
Tobramvrin 6 (12.2%) 22 (6.8%) 0.29
Trimethoprim/suIfamethoxazole 30 (61.2%) 80 (24.6%) <0.05

∗ By the Chi-square test. Abbreviation: CA-ESBL; community-acquired extended-spectrum B-lactamase.

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