title: Extended-spectrum β-lactamase-producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre.
abstract: OBJECTIVE
  The last decade has seen a significant increase in extended-spectrum β-lactamase (ESBL) secreting organisms responsible for paediatric urinary tract infections (UTIs), particularly in community-acquired infections. These expose patients to the risks of antibiotic treatment failure and renal scarring. This prospective study examined the prevalence and risk factors of febrile ESBL UTIs and their treatment in the paediatric emergency department of a university hospital.
  
  
  METHODS
  In this prospective observational study, all children from 0 to 16 years of age with febrile UTIs were included from May 2012 to April 2013. Cases with and without ESBL involvement were compared.
  
  
  RESULTS
  Of the 474 diagnosed febrile UTIs, 22 (4.6%) with a 95% confidence interval (95% CI) of 2.9-6.9 were due to an ESBL-producing organism. Escherichia coli was found in 85% of cases. Significant odds ratios (OR) for ESBL urinary tract infections were prior hospitalisation (OR 4.1, 95% CI 1.6-10.8), urinary tract abnormalities (OR 3.9, 95% CI 1.5-10.2) and previous antibiotic treatment (OR 3.1, 95% CI 1.2-8.8). All ESBL urinary tract infections had positive outcomes.
  
  
  CONCLUSIONS
  The prevalence of febrile ESBL urinary tract infections was less than 5% in a paediatric emergency department. This low rate was not high enough to justify changing our guidelines.
authors.affiliation: Paediatric Emergency Department, APHP, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jacmel
authors.affiliation: Paediatric Emergency Department, APHP, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Timsit
authors.affiliation: Department of Microbiology, APHP, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Ferroni
authors.affiliation: Paediatric Emergency Department, APHP, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Auregan
authors.affiliation: Paediatric Emergency Department, APHP, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: François
authors.identifier: http://orcid.org/0000-0002-4204-7603
authors.initials: F
authors.lastname: Angoulvant
authors.affiliation: Paediatric Emergency Department, APHP, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Chéron
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006090:Gram-Negative Bacteria / Q000201:enzymology* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D006094:Gram-Positive Bacteria / Q000201:enzymology* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D015415:Biomarkers; D001618:beta-Lactamases
keywords: 
  Escherichia coli
  ; Beta-lactamase; Emergency department; Extended-spectrum β-lactamase; Urinary tract infections