Abstract
PEDIATRIC RISK FACTORS AND CHARACTERISTICS OF URINARY TRACT INFECTIONS CAUSED BY ESBL VERSUS NON ESBL ORGANISMS AT MAKASSED GENERAL HOSPITAL

Majdi Said*, Soha Ghanem, Mariam Rajab, Amal Naous, Bassem Abou Merhi

ABSTRACT

Background: Urinary tract infections (UTIs) are among the most common infectious diseases in pediatrics encountered in the community and in the hospital. Resistance to antibiotics in members of Gram-negative Enterobacteriaceae rose tremendously; highlighted by the emergence of extended spectrum beta-lactamase (ESBL) producing organisms. The incidence of community-onset UTIs caused by ESBL-producing E. coli in children is increasing and the previous use of antibiotics was considered a major risk factor. Objectives: To determine the risk factors of community-onset UTIs caused by ESBL-producing E. coli in children, study the difference in presentation and laboratory with radiologic findings with those who have non ESBL isolates UTI, and to assess the rate and antibiotics susceptibility of the ESBL isolates. Methods: A retrospective cross-sectional study was conducted at Makassed General Hospital in Beirut. Subjects were identified by the following ICD-10 discharge codes: “Urinary tract infection”, “Cystitis”, and “Pyelonephritis.” Children between 1 month and 18 years of age admitted for UTI between January 1st, 2012 and December 31st, 2017 were included. Cases whose urine culture result did not meet our definition for UTI or showed no growth and patients who had long stay at hospital were excluded. Results: During the study period, 292 charts have been reviewed, 14 patients were excluded, the remaining 278 were divided into 2 groups; ESBL (103 cases) and non ESBL (175 cases) isolated pathogens with a female predominance (85%). Vesico-ureteral reflux and previous antibiotics use with recent hospitalization and recurrent UTI were found to be independent risk factors for ESBL-producing E. coli and Klebsiella spp. (p < 0.05). Presenting fever was found most common in non ESBL group compared to ESBL (72.3% vs. 56.3% respectively; p-value=0.008), in contrast to dysuria which was more common in ESBL group (35.9% vs. 20.3%; p-value=0.005). Laboratory and radiologic findings showed no statistical significance, however advanced VUR was related to ESBL isolates. The proportions of ESBL-producing organisms causing UTI were increasing and they doubled over the study period (50%). A significant resistance to monobactam with cephalosporins and Bactrim was found >50%, however a complete sensitivity to carbapenems in ESBL pathogens is present. Conclusion: The recognition of risk factors for infection with ESBL-producing organisms and the observation of increasing resistance to antibiotics warrant further studies that might lead to new recommendations to guide management of UTIs and antibiotic use in children and adolescents.

Keywords: Urinary tract infections, E. coli and Klebsiella spp.


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