Risk Factors for Community-Acquired UTI With ESBL-Producing E coli in Children

Antibiotic use within the previous 3 months and Middle Eastern ethnic background were risk factors for community-acquired urinary tract infection (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in children treated at the Children’s Hospital of Michigan, according to study results published in Infectious Diseases.

In this single center retrospective study, researchers identified 111 cases of community-acquired UTI caused by ESBL-producing E coli from January 2012 to December 2016 and matched patients by age, gender, and year of infection to 103 control cases of community-acquired UTI with non-ESBL-producing E coli. The median ages in both groups was 4 years (range: 1 month to 18 years), and most patients were female (83% in ESBL group and 88% in non-ESBL group).

During the 5-year period, the percentage of ESBL-producing E coli UTI ranged from 7% to 15% of all UTI cases. ESBL-producing strains were more frequently resistant to trimethoprim-sulfamethoxazole (72% vs 25%) and ciprofloxacin (73% vs 5%) than strains not producing ESBL.

In the univariate analysis, significant risk factors for community-acquired UTI with ESBL-producing E coli compared with non-ESBL-producing E coli were as follows:

• Antibiotic usage in the last 3 months (54.5% vs 14.6%; P <.001)
• β-lactam use in the last 3 months (30.9% vs 8.8%; P <.001)
• Presence of vesicoureteral reflux (20.9% vs 5.9%; P =.002)
• UTI in the last 3 months (23.6% vs 5.9%; P <.001)
• Hospitalization in the last 3 months (24.5% vs 10.1%; P =.007)
• Middle Eastern ethnic background (30.6% vs 9.8%; P <.001)

The multivariate analysis, however, showed that only prior antibiotic usage (odds ratio [OR], 4.17; 95% CI, 1.85-9.09; P =.001) and Middle Eastern ethnic background (OR, 4.00; 95% CI, 1.69-9.09; P <.001) were independent risk factors.

Because of inconsistent documentation of symptoms, history, and physical examination results, researchers were unable to distinguish upper and lower UTI.

The study authors noted that “further investigation of the impact of antibiotic prophylaxis on the prevalence of UTIs with ESBL-producing E coli are warranted,” because “18% of patients with prior antibiotic use in the ESBL group were on long-term trimethoprim-sulfamethoxazole prophylaxis for [vesicoureteral reflux].”

In addition, researchers suggested that a history of international travel or of contact with international travelers should be explored when evaluating a child for possible community-acquired ESBL infection, because there was an increased risk for community-acquired ESBL-producing E coli among children of Middle Eastern ethnic background.

Reference

Zhu FH, Rodado MP, Asmar BI, Salimnia H, Thomas R, Abdel-Haq N. Risk factors for community acquired urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli in children: a case control study [published online August 20, 2019]. Infect Dis (Lond). doi:10.1080/23744235.2019.1654127