Childhood urinary tract infection caused by extended‐spectrum β‐lactamase‐producing bacteria: Risk factors and empiric therapy

Background This study investigated risk factors of childhood urinary tract infection (UTI) associated with extended‐spectrum β‐lactamase (ESBL)‐producing bacteria (ESBL‐positive UTI) and evaluated antimicrobial resistance as well as empiric treatment of childhood UTI. Methods The records of children with positive urine culture between 1 January 2008 and 31 December 2012 were evaluated. Patients with positive urine culture for ESBL‐producing bacteria were defined as the ESBL‐positive group, whereas patients of the same gender and similar age with positive urine culture for non‐ESBL‐producing bacteria were defined as the ESBL‐negative group. Each ESBL‐positive patient was matched with two ESBL‐negative patients. Results The ESBL‐positive and negative groups consisted of 154 and 308 patients, respectively. Potential risk factors for ESBL‐positive UTI were identified as presence of underlying disease, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months (P < 0.05). On logistic regression analysis, CIC, hospitalization and history of infection in the last 3 months were identified as independent risk factors. In the present study, 324 of 462 patients had empiric therapy. Empiric therapy was inappropriate in 90.3% of the ESBL‐positive group and in 4.5% of the ESBL‐negative group. Resistance to nitrofurantoin was similar between groups (5.1% vs 1.2%, P = 0.072); resistance to amikacin was low in the ESBL‐positive group (2.6%) and there was no resistance in the ESBL‐negative group. Conclusions Clean intermittent catheterization, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL‐positive UTI. The combination of ampicillin plus amikacin should be taken into consideration for empiric therapy in patients with acute pyelonephritis who have the risk factors for ESBL‐positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis.