title: Extended spectrum beta lactamase (ESBL) producing bacteria urinary tract infections and complex pediatric urology.
abstract: OBJECTIVE
  Extended spectrum beta lactamase (ESBL) producing bacteria are resistant to most beta-lactam antibiotics including third-generation cephalosporins, quinolones and aminoglycosides. This resistance is plasmid-borne and can spread between species. Management of ESBL is challenging in children with recurrent urinary tract infections (UTIs) and complex urological abnormalities. We aim to quantify the risk in children and specifically in urological patients.
  
  
  METHODS
  Retrospective review of a microbiology database (April 2014 to November 2015). This identified urine isolates, pyuria, ESBL growth and patient demographics. Data analysis was by Chi square, Mann-Whitney U-test and ANOVA. A P value of <0.05 was taken as significant.
  
  
  RESULTS
  Analysis of 9418 urine samples showed 2619 with pure isolates, of which 1577 had pyuria (>10×106WC/L). 136 urine cultures (n=79 patients) grew purely ESBL. Overall, 5.2% of urine isolates were ESBL and 9.5% isolates with pyuria (>100×106WC/L) had ESBL, whereas only 22/1032 (2.1%) with no pyuria, (P<0.0001). Urology patients had 86/136 (63%) ESBL positive cultures. These represented 86/315 (27%) of all positive cultures for urology patients vs. 50/2267 (2.2%) for all other specialties (P<0.0001). Potential ESBL transmission between organisms occurred in 3 (all on prophylactic antibiotics). Over the study period, there was no significant rise of the monthly incidence between 2014 and 2015 (ANOVA P=0.1).
  
  
  CONCLUSIONS
  This study is the first to document the incidence of ESBL in children (5%), and estimate the frequency of possible plasmid transmission between bacterial species in children. This quantifies the risk of ESBL, especially to urology patients, and mandates better antibiotic stewardship.
  
  
  METHODS
  Level IIc.
authors.affiliation: Department of Pediatric Urology, Birmingham Children's Hospital.
authors.forename: Ruth
authors.initials: R
authors.lastname: Wragg
authors.affiliation: Department of Pediatric Urology, Birmingham Children's Hospital.
authors.forename: Anna
authors.initials: A
authors.lastname: Harris
authors.affiliation: Department of Microbiology, Birmingham Children's Hospital.
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Pediatric Urology, Birmingham Children's Hospital.
authors.forename: Andrew
authors.initials: A
authors.lastname: Robb
authors.affiliation: Department of Pediatric Urology, Birmingham Children's Hospital.
authors.forename: Harish
authors.initials: H
authors.lastname: Chandran
authors.affiliation: Department of Pediatric Urology, Birmingham Children's Hospital. Electronic address: liam.mccarthy@bch.nhs.uk.
authors.forename: Liam
authors.initials: L
authors.lastname: McCarthy
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology* / Q000652:urine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology* / Q000652:urine; D014564:Urogenital Abnormalities / Q000150:complications*; D018440:beta-Lactam Resistance; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams
keywords: Antibiotic resistance; Antibiotic stewardship; ESBL; Urinary tract abnormality; Urinary tract infection