title: Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study.
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.
  
  
  METHODS
  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.affiliation: Department of Pediatrics, Western Galilee Hospital, Nahariya, Israel.
authors.forename: Noam
authors.initials: N
authors.lastname: Dayan
authors.forename: Husein
authors.initials: H
authors.lastname: Dabbah
authors.forename: Irith
authors.initials: I
authors.lastname: Weissman
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aga
authors.forename: Lea
authors.initials: L
authors.lastname: Even
authors.forename: Daniel
authors.initials: D
authors.lastname: Glikman
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D004755:Enterobacteriaceae / Q000201:enzymology*; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D001618:beta-Lactamases
keywords: AAP; American Academy of Pediatrics; CA; Community-acquired; ESBL; Extended-spectrum β-lactamase; Trimet/Sulfa; Trimethoprim-sulfamethoxazole; UTI; Urinary tract infection; WGH; Western Galilee Hospital