Clinical Significance of Extended-spectrum β-lactamase-producing Bacteria in First Pediatric Febrile Urinary Tract Infections and Differences between Age Groups
Childhood Kidney Diseases
; : 128-135, 2017.
Article
in English
| WPRIM (Western Pacific)
| ID: wpr-136724
Responsible library:
WPRO
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.
Full text:
Available
Health context:
Sustainable Health Agenda for the Americas
Health problem:
Goal 1 Equitable access to health services
Database:
WPRIM (Western Pacific)
Main subject:
Recurrence
/
Bacteria
/
Urinary Tract
/
Urinary Tract Infections
/
C-Reactive Protein
/
Carbapenems
/
Cephalosporins
/
Retrospective Studies
/
Aminoglycosides
/
Hospitalization
Type of study:
Observational study
/
Prognostic study
Limits:
Child
/
Humans
/
Infant
Language:
English
Journal:
Childhood Kidney Diseases
Year:
2017
Document type:
Article