Risk factors for pediatric community-acquired febrile urinary tract infections due to resistant bacteria and treatment options: a French retrospective case-control study (FRIUPed).

BACKGROUND

Febrile urinary tract infection (FUTI) is one of the most common bacterial infections in children. Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) involved in these infections are increasing worldwide. The aim of this study is to establish risk factors (RFs) for developing community-acquired FUTI due to ESBLE in children. The secondary objectives are to analyze therapeutic options used in probabilistic and definitive treatments and their efficacy.

METHODS

In this single-center, retrospective, case-control study conducted at Toulouse Children's Hospital between 1st January 2016 and 31 December 2020, we identified all children hospitalized for FUTI. ESBLE-mediated FUTI was the case group. The control group comprising non-ESBLE-mediated FUTIs was randomly selected and matched according to age and year of diagnosis with a ratio of 1 case for 3 controls.

RESULTS

264 children were enrolled, 66 in the ESBLE-mediated FUTIs group and 198 in the non-ESBLE-mediated FUTIs group. RFs found to be significant were antibiotic therapy in the previous 3 months (p 0.0018); hospitalization in the previous 3 months (p<0.001); hospitalization in an intensive care unit in the previous 3 months (p<0.016); recurrence of FUTI whatever the delay (p 0.042); travel to a highly endemic area in the previous 3 months (p 0.003); a history of infection due to resistant bacteria (p<0.001); CAKUT (p 0.018); antibiotic prophylaxis (p 0.045); the number of days presenting fever prior to diagnosis (p 0.03). In multivariate analysis, the independent RFs were: hospitalization in the previous 3 months (ORa 3.6 [1.9-6.9]), history of infection due to resistant bacteria (ORa 20.9 [5-311]) and the number of days presenting fever prior to diagnosis (ORa 1.3 [1.1-1.6]).

CONCLUSION

Identifying risk factors for developing community-acquired FUTI due to ESBLE may allow for better management of patients.