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The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection.
- Source :
-
Pediatrics and neonatology [Pediatr Neonatol] 2024 May; Vol. 65 (3), pp. 242-248. Date of Electronic Publication: 2023 Oct 20. - Publication Year :
- 2024
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Abstract
- 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.<br />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.<br />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 (X <superscript>2</superscript>  = 11.83, p < 0.01) and a preterm gestational history (X <superscript>2</superscript>  = 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 % (X <superscript>2</superscript>  = 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.<br />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.<br />Competing Interests: Declaration of competing interest All authors declare that there is no conflict of interest regarding the publication of this paper.<br /> (Copyright © 2023 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Humans
Retrospective Studies
Female
Male
Risk Factors
Infant
Child, Preschool
Child
Taiwan epidemiology
Anti-Bacterial Agents therapeutic use
Escherichia coli drug effects
Infant, Newborn
Proteus mirabilis drug effects
Proteus mirabilis enzymology
Drug Resistance, Bacterial
Incidence
Escherichia coli Infections drug therapy
Escherichia coli Infections microbiology
Urinary Tract Infections drug therapy
Urinary Tract Infections microbiology
Urinary Tract Infections epidemiology
beta-Lactamases
Klebsiella pneumoniae drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 2212-1692
- Volume :
- 65
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Pediatrics and neonatology
- Publication Type :
- Academic Journal
- Accession number :
- 37951832
- Full Text :
- https://doi.org/10.1016/j.pedneo.2023.04.021