Infect Chemother.  2009 Dec;41(6):333-341. 10.3947/ic.2009.41.6.333.

Risk Factors for Community-onset Urinary Tract Infections due to Extended-spectrum beta-lactamase Producing Bacteria in Children

• Kim NH
• Kim JH
• Lee TJ

• KMID: 2285038
• DOI: http://doi.org/10.3947/ic.2009.41.6.333

Abstract

BACKGROUND
Extended-spectrum beta-lactamase (ESBL) producing bacteria have been increasingly recognized in the community. The aim of this study was to identify risk factors for community-onset urinary tract infections (UTIs) by ESBL producers in children. MATERIALS AND METHODS: We analyzed 854 episodes of community-onset UTIs in children diagnosed at CHA Bundang Medical Center from January, 2004 to April, 2009. The presence of ESBL in Escherichia coli and Klebsiella spp. was screened and confirmed by VITEK(R)-2 ESBL test. Controls were matched in a 2:1 ratio to case patients by age and sex. The clinical characteristics, risk factors, antimicrobial resistance, and treatment efficacy were compared with controls. RESULTS: The most common pathogen was Escherichia coli (681 isolates), followed by Klebsiella pneumoniae (60 isolates), Enterococcus faecalis (23 isolates), etc. The number of isolated ESBL producers among the pathogens E. coli and K. pneumoniae was 25 (3.7%) and 7 isolates (11.7%), respectively. No significant differences were noted as to the UTI history prior to the present treatment, underlying urogenital anomaly, and clinical characteristics. Use of any antibiotics within a month (P=0.012, Odds ratio, 6.341, 95% confidence interval, 1.492 to 26.955) was related to the increased risk of community-onset UTI by ESBL producers. Conclusion: ESBL-producing bacteria has been identified in pediatric community-onset UTI, and the use of any antibiotics within the previous month was related to the increased risk of UTI by ESBL producers. Therefore, careful selection and use of antibiotics should be recommended for community-onset UTI in children.

Keyword

Extended-spectrum beta-lactamase; Urinary tract infection; Children

MeSH Terms

Anti-Bacterial Agents
Bacteria
beta-Lactamases
Child
Enterococcus faecalis
Escherichia coli
Humans
Klebsiella
Klebsiella pneumoniae
Odds Ratio
Pneumonia
Risk Factors
Treatment Outcome
Urinary Tract
Urinary Tract Infections
Anti-Bacterial Agents
beta-Lactamases

Reference

1. Elder JS. Urinary tract infections. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of Pediatrics. 18th ed. Philadelphia: W.B. Saunders Co.; 2007. pp. 2223-2228.

2. Prajapati BS, Prajapati RB, Patel PS. Advances in management of urinary tract infections. Indian J Pediatr. 2008; 75:809–814.

3. Lee SY, Lee JH, Kim JH, Hur JK, Kim SM, Ma SH, Kang JH. Susceptibility tests of oral antibiotics including cefixime against Escherichia coli, isolated from pediatric patients with community acquired urinary tract infections. Korean J Pediatr. 2006; 49:777–783.

4. Pitout JD, Nordmann P, Laupland KB, Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother. 2005; 56:52–59.

5. Lee JW, Shin JS, Seo JW, Lee MA, Lee SJ. Incidence and risk factors for extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired childhood urinary tract infection. J Korean Soc Pediatr Nephrol. 2004; 8:214–222.

6. Peña C, Pujol M, Ricart A, Ardanuy C, Ayats J, Liñares J, Garrigosa F, Ariza J, Gudiol F. Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum beta-lactamase (ESBL-KP) in the intensive care unit. J Hosp Infect. 1997; 35:9–16.

7. Rice LB. Successful interventions for gram-negative resistance to extended-spectrum beta-lactam antiobiotics. Pharmacotherapy. 1999; 19:120S–128S. discussion 133S-7S, 1999.

8. Demir S, Soysal A, Bakir M, Kaufmann ME, Yagci A. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in paediatric wards: a nested case-control study. J Paediatr Child Health. 2008; 44:548–553.

9. Hwang MH, Lee HK, Kim HJ, Min YS, Park KB, Park JS, Kim YC, Cho SR. Clinical and molecular-biologic study of extended spectrum beta-lactamase producing Klebsiella pneumoniae in a neonatal intensive care unit. J Korean Soc Neonatol. 2001; 8:25–32.

10. Jun NL, Im JW, Park HK, Kim MN, Kim EA, Kim KS, Pi SY. Clinical characteristics and epidemiologic study of infection due to extended spectrum beta-lactamase producing organism in a neonatal intensive care unit. Korean J Pediatr. 2004; 47:373–379.

11. Kim YK, Pai H, Lee HJ, Park SE, Choi EH, Kim J, Kim JH, Kim EC. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother. 2002; 46:1481–1491.

12. Calbo E, Romaní V, Xercavins M, Gómez L, Vidal CG, Quintana S, Vila J, Garau J. Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother. 2006; 57:780–783.

13. Colodner R, Rock W, Chazan B, Keller N, Guy N, Sakran W, Raz R. Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis. 2004; 23:163–167.

14. Rodríguez-Baño J, Navarro MD, Romero L, Martínez-Martínez L, Muniain MA, Perea EJ, Pérez-Cano R, Pascual A. Epidemiology and clinical features of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in nonhospitalized patients. J Clin Microbiol. 2004; 42:1089–1094.

15. Robin F, Delmas J, Schweitzer C, Bonnet R. Evaluation of the Vitek-2 extended-spectrum beta-lactamase test against non-duplicate strains of Enterobacteriaceae producing a broad diversity of well-characterised beta-lactamases. Clin Microbiol Infect. 2008; 14:148–154.

16. Lamotte-Brasseur J, Knox J, Kelly JA, Charlier P, Fonzé E, Dideberg O, Frére JM. The structures and catalytic mechanisms of active-site serine beta-lactamases. Biotechnol Genet Eng Rev. 1994; 12:189–230.

17. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005; 18:657–686.

18. Cantón R, Novais A, Valverde A, Machado E, Peixe L, Baquero F, Coque TM. Prevalence and spread of extended-spectrumbeta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect. 2008; 14 Suppl 1:144–153.

19. Rodríguez-Baño J, Navarro MD, Romero L, Muniain MA, de Cueto M, Ríos MJ, Hernández JR, Pascual A. Bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in the CTX-M era: a new clinical challenge. Clin Infect Dis. 2006; 43:1407–1414.

20. Goossens H, Grabein B. Prevalence and antimicrobial susceptibility data for extended-spectrum beta-lactamase- and AmpC-producing Enterobacteriaceae from the MYSTIC program in Europe and the United States (1997-2004). Diagn Microbiol Infect Dis. 2005; 53:257–264.

21. Hirakata Y, Matsuda J, Miyazaki Y, Kamihira S, Kawakami S, Miyazawa Y, Ono Y, Nakazaki N, Hirata Y, Inoue M, Turnidge JD, Bell JM, Jones RN, Kohno S. SENTRY Asia-Pacific Participants. Regional variation in the prevalence of extended-spectrum beta-lactamase-producing clinical isolates in the Asia-Pacific region (SENTRY 1998-2002). Diagn Microbiol Infect Dis. 2005; 52:323–329.

22. Bell JM, Turnidge JD, Gales AC, Pfaller MA, Jones RN. Sentry APAC Study Group. Prevalence of extended spectrum beta-lactamase (ESBL)-producing clinical isolates in the Asia-Pacific region and South Africa: regional results from SENTRY Antimicrobial Surveillance Program (1998-99). Diagn Microbiol Infect Dis. 2002; 42:193–198.

23. Jeong SH, Bae IK, Kwon SB, Lee JH, Jung HI, Song JS, Jeong BC, Kim SJ, Lee SH. Investigation of extended-spectrum beta-lactamases produced by clinical isolates of Klebsiella pneumoniae and Escherichia coli in Korea. Lett Appl Microbiol. 2004; 39:41–47.

24. Jeong SH, Bae IK, Lee JH, Sohn SG, Kang GH, Jeon GJ, Kim YH, Jeong BC, Lee SH. Molecular characterization of extended-spectrum beta-lactamases produced by clinical isolates of Klebsiella pneumoniae and Escherichia coli from a Korean nationwide survey. J Clin Microbiol. 2004; 42:2902–2906.

25. Kim J, Lim YM. Prevalence of derepressed ampC mutants and extended-spectrum beta-lactamase producers among clinical isolates of Citrobacter freundii, Enterobacter spp. , and Serratia marcescens in Korea: dissemination of CTX-M-3, TEM-52, and SHV-12. J Clin Microbiol. 2005; 43:2452–2455.

26. Pai H. The characteristics of extended-spectrum beta-lactamases in Korean isolates of Enterobacteriaceae. Yonsei Med J. 1998; 39:514–519.

27. Ryoo NH, Kim EC, Hong SG, Park YJ, Lee K, Bae IK, Song EH, Jeong SH. Dissemination of SHV-12 and CTX-M-type extended-spectrum beta-lactamases among clinical isolates of Escherichia coli and Klebsiella pneumoniae and emergence of GES-3 in Korea. J Antimicrob Chemother. 2005; 56:698–702.

28. Ko KS, Lee MY, Song JH, Lee H, Jung DS, Jung SI, Kim SW, Chang HH, Yeom JS, Kim YS, Ki HK, Chung DR, Kwon KT, Peck KR, Lee NY. Prevalence and characterization of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated in Korean hospitals. Diagn Microbiol Infect Dis. 2008; 61:453–459.

29. Chow JW, Satishchandran V, Snyder TA, Harvey CM, Friedland IR, Dinubile MJ. In vitro susceptibilities of aerobic and facultative gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2002 Study for Monitoring Antimicrobial Resistance Trends (SMART). Surg Infect (Larchmt). 2005; 6:439–448.

30. Valverde A, Coque TM, Sánchez-Moreno MP, Rollán A, Baquero F, Cantón R. Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during non-outbreak situations in Spain. J Clin Microbiol. 2004; 42:4769–4775.

31. Borer A, Gilad J, Menashe G, Peled N, Riesenberg K, Schlaeffer F. Extended-spectrum beta-lactamase-producing Enterobacteriaceae strains in community-acquired bacteremia in Southern Israel. Med Sci Monit. 2002; 8:CR44–CR47.

32. Ben-Ami R, Schwaber MJ, Navon-Venezia S, Schwartz D, Giladi M, Chmelnitsky I, Leavitt A, Carmeli Y. Influx of extended-spectrum beta-lactamase-producing Enterobacteriaceae into the hospital. Clin Infect Dis. 2006; 42:925–934.

33. Kim NH, Lee JA, Kim YK, Choi EH, Ha IS, Lee HJ, Choi Y. Risk factors of urinary tract infections due to extended-spectrum beta-lactamase producing Escherichia coli in children. Korean J Pediatr. 2004; 47:164–169.

34. Peterson LR. Antibiotic policy and prescribing strategies for therapy of extended-spectrum beta-lactamase-producing Enterobacteriaceae: the role of piperacillin-tazobactam. Clin Microbiol Infectl. 2008; 14 Suppl 1:181–184.

35. Rupp ME, Fey PD. Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs. 2003; 63:353–365.

36. Harada S, Ishii Y, Yamaguchi K. Extended-spectrum beta-lactamases: implications for the clinical laboratory and therapy. Korean J Lab Med. 2008; 28:401–412.

37. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008; 8:159–166.

38. Rodríguez-Baño J, Navarro MD. Extended-spectrum beta-lactamases in ambulatory care: a clinical perspective. Clin Microbiol Infect. 2008; 14 Suppl 1:104–110.

39. Arslan H, Azap OK, Ergönül O, Timurkaynak F. Urinary Tract Infection Study Group. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother. 2005; 56:914–918.

40. Warren RE, Ensor VM, O\'Neill P, Butler V, Taylor J, Nye K, Harvey M, Livermore DM, Woodford N, Hawkey PM. Imported chicken meat as a potential source of quinolone-resistant Escherichia coli producing extended-spectrum beta-lactamases in the UK. J Antimicrob Chemother. 2008; 61:504–508.