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

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.