title: Community-acquired febrile urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in hospitalised infants.
abstract: BACKGROUND
  Extended-spectrum beta-lactamase (ESBL) producing bacteria are infrequent pathogens of urinary tract infections in children. The objective of our study was to investigate the presence, clinically associated characteristics and risk factors for acquisition of urinary tract infection/acute pyelonephritis (UTI/APN) in hospitalised children <2years old caused by community-acquired ESBL.
  
  
  METHODS
  A case-control study in a second level community hospital in Spain, in which 537 episodes of UTI/APN were investigated in a retrospective study between November 2005 and August 2014. Cases were patients with ESBL strains. For each case, four ESBL-negative controls were selected. A questionnaire with the variables of interest was completed for every patient, and the groups were compared.
  
  
  RESULTS
  ESBL-positive strains were found in 19 (3,5%) cultures. Of these 16 (84%) were Escherichia coli. Vesicoureteral reflux (VUR) of any grade was more frequent in the ESBL group (60 vs. 29%), although without statistical significance. Relapses were more frequent in the ESBL group (42% vs. 18%) (P=.029; OR=3.2; 95%CI: 1.09-9.5). The prevalence of UTI/APN due to ESBL-positive strains increased slightly from 2.7% in the period 2005-2009 to 4.4% in the period 2010-2014.
  
  
  CONCLUSIONS
  ESBL UTI/APN were associated with more frequent relapses. VUR of any grade was twice more frequent in the ESBL group. Piperacillin/tazobactam, fosfomycin and meropenem showed an excellent activity. Aminoglycosides may be a therapeutic option, and in our patients gentamicin was the antibiotic most used.
authors.affiliation: Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universitat de València, Valencia, España.
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernández Marco
authors.affiliation: Facultad de Medicina y Odontología, Universitat de València, Valencia, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Guillén Olmos
authors.affiliation: Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universitat de València, Valencia, España. Electronic address: breton_raf@gva.es.
authors.forename: José Rafael
authors.initials: JR
authors.lastname: Bretón-Martínez
authors.affiliation: Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Giner Pérez
authors.affiliation: Servicio de Microbiología Cínica, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Microbiología y Ecología, Universitat de València, Valencia, España.
authors.forename: Benedicta
authors.initials: B
authors.lastname: Casado Sánchez
authors.affiliation: Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España.
authors.forename: Julia
authors.initials: J
authors.lastname: Fujkova
authors.affiliation: Servicio de Pediatría, Hospital Universitario Doctor Peset, Valencia, España.
authors.forename: Marina
authors.initials: M
authors.lastname: Salamanca Campos
authors.affiliation: Servicio de Microbiología Cínica, Hospital Universitario Doctor Peset, Valencia, España; Departamento de Microbiología y Ecología, Universitat de València, Valencia, España.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Nogueira Coito
mesh_terms: D001426:Bacterial Proteins / Q000032:analysis*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D015897:Comorbidity; D004926:Escherichia coli / Q000201:enzymology / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005334:Fever / Q000209:etiology; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D011704:Pyelonephritis / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases
keywords: Betalactamasas de espectro extendido; Community-acquired infection; Extended-spectrum beta-lactamases-producing bacteria; Factores de riesgo; Infants; Infección adquirida en la comunidad; Infección urinaria; Niños; Risk factors; Urinary tract infection