Predictive factors of urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli in children: a prospective Tunisian study.

Abstract

AIM: To identify the predictive factors for the occurrence of community-acquired urinary tract infections caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli in children. METHODS: This was a single-center prospective observational study of children and young adults with community-acquired urinary tract infections caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli. The study was conducted in the pediatric nephrology department in Charles Nicolle Hospital, Tunis, Tunisia from January 1st, 2019, to December 31, 2020. Patients ≤20 years with community-acquired urinary tract infection caused by Escherichia coli were included prospectively in our study. RESULTS: We collected 290 urinary tract infections in 218 patients, including 92 urinary tract infections due to Extended-Spectrum β-Lactamase-Producing Escherichia coli. The mean age of children was 50.10±54.28 months, with a female predominance in 65.2% of cases. Risk factors for the acquisition of multidrug-resistant bacteria were antibiotic therapy in the previous three months, antibiotic prophylaxis, hospitalization in the year preceding the urinary tract infections, and outpatient care in the previous six months (p < 0.05). Resistance to Ceftazidime, Cefotaxime, Cefixime, Gentamicin and Ofloxacin was significantly associated with the presence of an Extended-Spectrum β-Lactamase strain. Antibiotic resistance was significantly more observed in the age group above 6 years. Co-habitation with health care worker was a risk factor for resistance to Amoxicillin-Clavulanic Acid. CONCLUSION: Understanding the epidemiological profile and risk factors for ESBL-producing UTIs, including Extended-Spectrum β-Lactamase-producing Escherichia coli in the pediatric population, could improve the therapeutic approach and lead to more rational prescription of antibiotics.