title: Urinary tract infection caused by community-acquired extended-spectrum β-lactamase-producing bacteria in infants.
abstract: OBJECTIVE
  Urinary tract infection (UTI) caused by resistant strains of bacteria is increasingly prevalent in children. The aim of this study was to investigate the clinical characteristics and risk factors for UTI caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing bacteria in infants.
  
  
  METHODS
  This was a retrospective study performed over 5 years in a single Korean center. Hospitalized infants with febrile UTI were enrolled and divided into two groups (CA-ESBL vs. CA non-ESBL UTI). The yearly prevalence was calculated. Baseline characteristics and clinical course such as fever duration, laboratory and radiological findings were compared between the two groups. Risk factors associated with the CA-ESBL UTI were investigated.
  
  
  RESULTS
  Among the enrolled infants (n=185), 31 (17%) had CA-ESBL UTI. The yearly prevalence of ESBL of CA-ESBL UTI increased during the study (0% in 2010, 22.2% in 2015). Infants with CA-ESBL UTI had a longer duration of fever after initiating antibiotics (2.0±1.1 vs. 1.5±0.6 days, p=0.020). Cortical defects on renal scan and early treatment failure were more frequent in CA-ESBL (64.5 vs. 42.2%, p=0.023; 22.6 vs. 4.5%, p=0.001). A logistic regression analysis revealed that urinary tract abnormalities and previous UTI were independent risk factors for CA-EBSL UTI (odds ratio, 2.7; p=0.025; 10.3; p=0.022).
  
  
  CONCLUSIONS
  The incidence of UTI caused by ESBL-producing bacteria has increased in Korean infants. Recognition of the clinical course and risk factors for ESLB-producing UTI may help to determine appropriate guidelines for its management.
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: emyang@chonnam.ac.kr.
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Yang
authors.affiliation: Chonnam National University Hospital, Gwangju, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Chan Jong
authors.initials: CJ
authors.lastname: Kim
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification / Q000627:therapeutic use; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D004351:Drug Resistance; D004812:Epidemiologic Methods; D004926:Escherichia coli; D005260:Female; D006801:Humans; D007709:Klebsiella; D008297:Male; D056910:Republic of Korea / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Antimicrobial resistance; Fatores de risco; Infant; Infecção do trato urinário; Neonato; Resistência antimicrobiana; Risk factors; Urinary tract infection; β-Lactamase