Risk Factors of Urinary Tract Infections Due to Extended-spectrum beta-lactamase Producing Escherichia coli in Children

Kim, Nam Hee; Lee, Jin A; Kim, Yun Kyung; Choi, Eun Hwa; Ha, Il Soo; Lee, Hoan Jong; Choi, Yong

Abstract

PURPOSE
This study was performed to identify risk factors for urinary tract infection(UTI) by extended-spectrum beta-lactamase(ESBL)-producing Escherichia coli in children.
METHODS
We analyzed 125 episodes of UTI which were developed in 112 children at the Seoul National University Children's Hospital from July to December 2002. Medical records of 74 episodes of UTI caused by E. coli were reviewed in a search for possible risk factors of infection by ESBL producers. The presence of ESBL in E. coli was screened and confirmed by the National Committee for Clinical Laboratory Standards guidelines and/or double disk synergy test.
RESULTS
The most common isolates were E. coli(74 isolates), followed by Enterobacter spp.(nine isolates) and Klebsillea spp.(eight isolates). Fifteen isolates were gram positive microorganisms. The prevalence of ESBL producers among 74 strains of E. coli was 18%(13 isolates). Previous hospitalization within six months(P=0.001; odds ratio[OR], 8.72, 95% confidence interval[CI], 1.87 to 40.6) and prior use of extended-spectrum cephalosporins within a month(P=0.009; OR,10.94, 95% CI, 1.59 to 75.4) were associated with the increased risk of UTI by ESBL-producing E. coli. However, age, sex, and the underlying urogenital anomalies did not contribute to the development of UTI by ESBL-producing E. coli.
CONCLUSION
ESBL-producing strains of E. coli have been increasingly recognized in pediatric UTI. Previous use of antibiotics was related to the risk of infection by ESBL-producers. Therefore, prudent use of antibiotics should be recommended for antimicrobial therapy in children.