Clinical Significance of Extended-spectrum β-lactamase-producing Bacteria in First Pediatric Febrile Urinary Tract Infections and Differences between Age Groups.
10.3339/jkspn.2017.21.2.128
- Author:
Sun Yeong PARK
1
;
Ji Hong KIM
Author Information
1. Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea. KKKJHD@yuhs.ac
- Publication Type:Original Article
- Keywords:
Extended-spectrum β-lactamase;
Urinary tract infection;
Age;
Cephalosporin
- MeSH:
Aminoglycosides;
Anti-Bacterial Agents;
Bacteria*;
C-Reactive Protein;
Carbapenems;
Cephalosporins;
Child;
Hospitalization;
Humans;
Infant;
Recurrence;
Retrospective Studies;
Urinary Tract Infections*;
Urinary Tract*
- From:Childhood Kidney Diseases
2017;21(2):128-135
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Extended-spectrum β-lactamase-producing bacteria-induced urinary tract infections are increasing and require more potent antibiotics such as carbapenems. We evaluated the clinical significance of extended-spectrum β-lactamase urinary tract infection in children younger than 5 years to select proper antibiotics and determine prognostic factors. Differences were compared between age groups. METHODS: We retrospectively studied 288 patients with their first febrile urinary tract infection when they were younger than 5 years. Patients were divided into extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative urinary tract infection groups. Clinical characteristics and outcomes were compared between the groups; an infant group was separately analyzed (onset age younger than 3 months). RESULTS: Extended-spectrum β-lactamase urinary tract infection occurred in 11% patients who had more frequent previous hospitalization (P=0.02) and higher recurrence rate (P=0.045). During the antimicrobial susceptibility test, the extendedspectrum β-lactamase-positive urinary tract infection group showed resistance to third-generation cephalosporins; however, 98% patients responded clinically. In the infant group, extended-spectrum β-lactamase-positive urinary tract infection occurred in 13% patients and was associated with a longer pre-onset hospitalization history (P=0.002), higher C-reactive protein level (P=0.04), and higher recurrence rate (P=0.02) than that in the older group. CONCLUSION: Extended-spectrum β-lactamase urinary tract infection requires more attention because of its higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins, but they can be used as first-line empirical antibiotics because of their high clinical response rate. Aminoglycosides can be second-line antibiotics before starting carbapenems when third-generation cephalosporins do not show bactericidal effects for extended-spectrum β-lactamase urinary tract infection.
