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Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study.
J Pediatr 2013; 163(5):1417-21JPed

Abstract

OBJECTIVE

To study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing Enterobacteriaceae.

STUDY DESIGN

A case-control study at a large community hospital in northern Israel, comparing children who had UTI due to CA-ESBL (n = 25) and CA non-ESBL (n = 125) in 2008-2011. Data were collected from medical charts, telephonic questionnaires administered to all participants, and groups were compared.

RESULTS

During the study period, the yearly incidence of CA-ESBL UTI increased significantly. There were no significant differences between the CA-ESBL and CA non-ESBL groups in demographics and clinical outcome. Compared with CA non-ESBL UTI, children with CA-ESBL UTI had a longer hospital stay (5.9 ± 3.3 vs 3.9 ± 2.3 days; P = .003) and higher rates of recent hospitalization (28% vs 4%; P = .001), previous UTI (40% vs 13%; P = .003), urinary tract anomalies (32% vs 5%; P < .001), UTI prophylaxis with cephalexin (32% vs 2%; P < .005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent hospitalization (OR 4.8 [CI 1.1-21]), and Klebsiella spp. UTI (OR 4.7 [CI 1.3-17]), were risk factors for CA-ESBL UTI.

CONCLUSIONS

Children prescribed UTI prophylaxis (due to urinary tract anomalies or recurrent UTI) with cephalexin and those with previous hospitalizations are at increased risk for CA-ESBL UTI. Although not associated with higher rates of complications, the multidrug resistant phenotype of CA-ESBL isolates poses a challenge in choosing appropriate empiric and definitive therapy and prolongs hospital stay.

Authors+Show Affiliations

Department of Pediatrics, Western Galilee Hospital, Nahariya, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23919903

Citation

Dayan, Noam, et al. "Urinary Tract Infections Caused By Community-acquired Extended-spectrum Β-lactamase-producing and Nonproducing Bacteria: a Comparative Study." The Journal of Pediatrics, vol. 163, no. 5, 2013, pp. 1417-21.
Dayan N, Dabbah H, Weissman I, et al. Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study. J Pediatr. 2013;163(5):1417-21.
Dayan, N., Dabbah, H., Weissman, I., Aga, I., Even, L., & Glikman, D. (2013). Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study. The Journal of Pediatrics, 163(5), pp. 1417-21. doi:10.1016/j.jpeds.2013.06.078.
Dayan N, et al. Urinary Tract Infections Caused By Community-acquired Extended-spectrum Β-lactamase-producing and Nonproducing Bacteria: a Comparative Study. J Pediatr. 2013;163(5):1417-21. PubMed PMID: 23919903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study. AU - Dayan,Noam, AU - Dabbah,Husein, AU - Weissman,Irith, AU - Aga,Ibrahim, AU - Even,Lea, AU - Glikman,Daniel, Y1 - 2013/08/03/ PY - 2013/04/18/received PY - 2013/06/10/revised PY - 2013/06/27/accepted PY - 2013/8/8/entrez PY - 2013/8/8/pubmed PY - 2014/1/1/medline KW - AAP KW - American Academy of Pediatrics KW - CA KW - Community-acquired KW - ESBL KW - Extended-spectrum β-lactamase KW - Trimet/Sulfa KW - Trimethoprim-sulfamethoxazole KW - UTI KW - Urinary tract infection KW - WGH KW - Western Galilee Hospital SP - 1417 EP - 21 JF - The Journal of pediatrics JO - J. Pediatr. VL - 163 IS - 5 N2 - OBJECTIVE: To study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing Enterobacteriaceae. STUDY DESIGN: A case-control study at a large community hospital in northern Israel, comparing children who had UTI due to CA-ESBL (n = 25) and CA non-ESBL (n = 125) in 2008-2011. Data were collected from medical charts, telephonic questionnaires administered to all participants, and groups were compared. RESULTS: During the study period, the yearly incidence of CA-ESBL UTI increased significantly. There were no significant differences between the CA-ESBL and CA non-ESBL groups in demographics and clinical outcome. Compared with CA non-ESBL UTI, children with CA-ESBL UTI had a longer hospital stay (5.9 ± 3.3 vs 3.9 ± 2.3 days; P = .003) and higher rates of recent hospitalization (28% vs 4%; P = .001), previous UTI (40% vs 13%; P = .003), urinary tract anomalies (32% vs 5%; P < .001), UTI prophylaxis with cephalexin (32% vs 2%; P < .005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent hospitalization (OR 4.8 [CI 1.1-21]), and Klebsiella spp. UTI (OR 4.7 [CI 1.3-17]), were risk factors for CA-ESBL UTI. CONCLUSIONS: Children prescribed UTI prophylaxis (due to urinary tract anomalies or recurrent UTI) with cephalexin and those with previous hospitalizations are at increased risk for CA-ESBL UTI. Although not associated with higher rates of complications, the multidrug resistant phenotype of CA-ESBL isolates poses a challenge in choosing appropriate empiric and definitive therapy and prolongs hospital stay. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/23919903/Urinary_tract_infections_caused_by_community_acquired_extended_spectrum_β_lactamase_producing_and_nonproducing_bacteria:_a_comparative_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(13)00837-8 DB - PRIME DP - Unbound Medicine ER -