The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection
Background: Extended-spectrum β-lactamases-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (ESBL-producing-EKP) are an increasingly common cause of childhood urinary tract infection (UTI) worldwide. Recognizing the risk factors and antimicrobial resistance patterns may guide...
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Elsevier
2024-05-01
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| Series: | Pediatrics and Neonatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957223001869 |
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| author | Xin-Tian He Chia-Ning Chang Chia-Hsiang Yu Chih-Chien Wang |
| author_facet | Xin-Tian He Chia-Ning Chang Chia-Hsiang Yu Chih-Chien Wang |
| author_sort | Xin-Tian He |
| collection | DOAJ |
| description | Background: Extended-spectrum β-lactamases-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (ESBL-producing-EKP) are an increasingly common cause of childhood urinary tract infection (UTI) worldwide. Recognizing the risk factors and antimicrobial resistance patterns may guide new management in this population. Methods: This is a retrospective cohort study of over 5 years in Taiwan (2017–2021). Inclusion criteria are hospitalized pediatric patients with the discharge diagnosis of UTI caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis. ESBL-producing-EKP and non-ESBL-producing-EKP UTI cases were reviewed for characteristics, urinary isolate antibiotics resistance, and clinical outcomes. Results: The incidence rate of ESBL-producing-EKP UTI increased over the study period (Overall incidence rate: 14.1 %, 46/327 patients). Recent antibiotic therapy in ≤6 months (X2 = 11.83, p < 0.01) and a preterm gestational history (X2 = 8.11, p < 0.05) were associated with an increased risk. The proportion of patients with these two risk factors for ESBL acquisition were 37.5 % (X2 = 9.08, p < 0.05). The co-resistance rate of ESBL-producing-EKP to other antimicrobial agents was 63.0 % for gentamicin, 56.5 % for trimethoprim-sulfamethoxazole, 52.2 % for ciprofloxacin, 4.3 % for amikacin, and 2.2 % for imipenem. The generalized linear model analysis identified a significantly longer length of stay (β: 2.85; 95 % confidence interval [CI]: 1.14–4.56; p < 0.01) and intensive care unit duration (β: 5.86; 95 % CI: 1.59–10.12; p < 0.01) among patients with ESBL-producing-EKP UTI. Conclusion: Amikacin should be considered as an alternative antimicrobial choice beyond carbapenems for ESBL-producing-EKP UTI, especially in the context of carbapenem-resistant E. coli/Klebsiella pneumoniae (CRE/CRKP) emergence. |
| format | Article |
| id | doaj-art-a81beabfc3324dbdaae97aa1c49f88fa |
| institution | DOAJ |
| issn | 1875-9572 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Pediatrics and Neonatology |
| spelling | doaj-art-a81beabfc3324dbdaae97aa1c49f88fa2025-08-20T03:18:49ZengElsevierPediatrics and Neonatology1875-95722024-05-0165324224810.1016/j.pedneo.2023.04.021The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infectionXin-Tian He0Chia-Ning Chang1Chia-Hsiang Yu2Chih-Chien Wang3Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Corresponding authorDepartment of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu District, Taipei City 114, Taiwan.Background: Extended-spectrum β-lactamases-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (ESBL-producing-EKP) are an increasingly common cause of childhood urinary tract infection (UTI) worldwide. Recognizing the risk factors and antimicrobial resistance patterns may guide new management in this population. Methods: This is a retrospective cohort study of over 5 years in Taiwan (2017–2021). Inclusion criteria are hospitalized pediatric patients with the discharge diagnosis of UTI caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis. ESBL-producing-EKP and non-ESBL-producing-EKP UTI cases were reviewed for characteristics, urinary isolate antibiotics resistance, and clinical outcomes. Results: The incidence rate of ESBL-producing-EKP UTI increased over the study period (Overall incidence rate: 14.1 %, 46/327 patients). Recent antibiotic therapy in ≤6 months (X2 = 11.83, p < 0.01) and a preterm gestational history (X2 = 8.11, p < 0.05) were associated with an increased risk. The proportion of patients with these two risk factors for ESBL acquisition were 37.5 % (X2 = 9.08, p < 0.05). The co-resistance rate of ESBL-producing-EKP to other antimicrobial agents was 63.0 % for gentamicin, 56.5 % for trimethoprim-sulfamethoxazole, 52.2 % for ciprofloxacin, 4.3 % for amikacin, and 2.2 % for imipenem. The generalized linear model analysis identified a significantly longer length of stay (β: 2.85; 95 % confidence interval [CI]: 1.14–4.56; p < 0.01) and intensive care unit duration (β: 5.86; 95 % CI: 1.59–10.12; p < 0.01) among patients with ESBL-producing-EKP UTI. Conclusion: Amikacin should be considered as an alternative antimicrobial choice beyond carbapenems for ESBL-producing-EKP UTI, especially in the context of carbapenem-resistant E. coli/Klebsiella pneumoniae (CRE/CRKP) emergence.http://www.sciencedirect.com/science/article/pii/S1875957223001869amikacinEnterobacteriaceaeextended-spectrum β-lactamasespediatricsurinary tract infection |
| spellingShingle | Xin-Tian He Chia-Ning Chang Chia-Hsiang Yu Chih-Chien Wang The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection Pediatrics and Neonatology amikacin Enterobacteriaceae extended-spectrum β-lactamases pediatrics urinary tract infection |
| title | The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection |
| title_full | The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection |
| title_fullStr | The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection |
| title_full_unstemmed | The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection |
| title_short | The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection |
| title_sort | risk factors antimicrobial resistance patterns and outcomes associated with extended spectrum β lactamases producing pathogens in pediatric urinary tract infection |
| topic | amikacin Enterobacteriaceae extended-spectrum β-lactamases pediatrics urinary tract infection |
| url | http://www.sciencedirect.com/science/article/pii/S1875957223001869 |
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