J Korean Soc Pediatr Nephrol.  2004 Oct;8(2):214-222.

Incidence and Risk Factors for Extended-Spectrum beta-Lactamase-Producing Escherichia coli in Community-acquired Childhood Urinary Tract Infection

• Lee JW
• Shin JS
• Seo JW
• Lee MA
• Lee SJ

Abstract

PURPOSE: Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended- Spectrum beta-Lactamase(ESBL) is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL(+) E. coli in community-acquired childhood UTI.
METHODS
In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI.
RESULTS
Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(+) E. coli compared with control patients (P< 0.05). Although ceftriaxone showed 100% resistance in ESBL(+) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%).
CONCLUSION
Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(+) E. coli UTI and changes in selection of empirical antibiotics shouldbe considered

Keyword

Extended-spectrum beta-lactamase; Escherichia coli; Community-aquired; Urinary tract infection

MeSH Terms

Anti-Bacterial Agents
Ceftriaxone
Child
Community-Acquired Infections
Cross Infection
Disease Outbreaks
Epidemiologic Studies
Escherichia coli*
Escherichia*
Female
Humans
Incidence*
Infant
Penicillins
Recurrence
Retrospective Studies
Risk Factors*
Sterilization
Treatment Outcome
Urinary Tract Infections*
Urinary Tract*
Anti-Bacterial Agents
Ceftriaxone
Penicillins