title: Childhood urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and empiric therapy.
abstract: BACKGROUND
  This study investigated risk factors of childhood urinary tract infection (UTI) associated with extended-spectrum β-lactamase (ESBL)-producing bacteria (ESBL-positive UTI) and evaluated antimicrobial resistance as well as empiric treatment of childhood UTI.
  
  
  METHODS
  The records of children with positive urine culture between 1 January 2008 and 31 December 2012 were evaluated. Patients with positive urine culture for ESBL-producing bacteria were defined as the ESBL-positive group, whereas patients of the same gender and similar age with positive urine culture for non-ESBL-producing bacteria were defined as the ESBL-negative group. Each ESBL-positive patient was matched with two ESBL-negative patients.
  
  
  RESULTS
  The ESBL-positive and negative groups consisted of 154 and 308 patients, respectively. Potential risk factors for ESBL-positive UTI were identified as presence of underlying disease, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months (P < 0.05). On logistic regression analysis, CIC, hospitalization and history of infection in the last 3 months were identified as independent risk factors. In the present study, 324 of 462 patients had empiric therapy. Empiric therapy was inappropriate in 90.3% of the ESBL-positive group and in 4.5% of the ESBL-negative group. Resistance to nitrofurantoin was similar between groups (5.1% vs 1.2%, P = 0.072); resistance to amikacin was low in the ESBL-positive group (2.6%) and there was no resistance in the ESBL-negative group.
  
  
  CONCLUSIONS
  Clean intermittent catheterization, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL-positive UTI. The combination of ampicillin plus amikacin should be taken into consideration for empiric therapy in patients with acute pyelonephritis who have the risk factors for ESBL-positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis.
authors: Department of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors: Nihal
authors: N
authors: Uyar Aksu
authors: Department of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.|Division of Pediatric Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors: Zelal
authors: Z
authors: Ekinci
authors: Department of Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors: Devrim
authors: D
authors: Dündar
authors: Department of Biostatistics and Medical Informatics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
authors: Canan
authors: C
authors: Baydemir
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents
keywords: child; extended-spectrum β-lactamase; risk factor; treatment; urinary tract infection