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Risk factors for community acquired pediatric urinary tract infection with extended-spectrum-β-lactamase Escherichia coli - A case-control study

Published:October 18, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.10.020

      Summary

      Introduction

      Community-acquired (CA) infections caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli urinary tract infections (UTI) have become increasingly prevalent, posing a serious threat to public health. Risk factors for ESBL UTI have not been extensively studied in the pediatric population. We report findings from a case control study to identify risk factors for CA ESBL-producing E. coli UTI in children.

      Materials and method

      A cohort of children with CA ESBL Escherichia coli UTI evaluated at a tertiary referral hospital from January 2014 through April 2021, were matched 1:3 with control group of non-ESBL CA E. coli UTI based on age at first episode of non-ESBL UTI. To identify potential risk factors for ESBL E. coli UTI, conditional logistic regression model was utilized accounting for age matching. Univariate models were fitted for each clinical risk factor. Factors found to be significantly associated with ESBL UTI were simultaneously included in a single model to check for associations adjusted for all other factors.

      Results

      On conditional multivariate analyses for univariate testing, male sex (P = 0.021), history of Urology care (P = 0.001), and antibiotic treatment within 30 days prior to positive culture (P = 0.004) were identified as independent risk factors for CA ESBL E. coli UTI. Comorbidity scores were assigned to each patient according to pediatric comorbidity index (PCI); children with ESBL UTI were more likely to have higher morbidity risk than non-ESBL UTI children (P < 0.001). From the logistic model, the higher the morbidity scores, the more likely children will have CA ESBL UTI (P < 0.001).

      Discussion

      Identifying risk factors for ESBL-producing E. coli UTI in children is important because of limited therapeutic options. This knowledge is essential for clinical decision making and to develop intervention strategies to reduce disease burden. Our study found that although females have an increased predisposition to UTIs, we observed that the male sex is an independent risk factor for ESBL E. coli UTI. This finding warrants further investigation to determine underlying cause. Because of the retrospective design of the study, collection of data from a single center, and differences in characteristics between patient populations, treatments, and prescribing patterns in the community, this study may not be generalizable.

      Conclusions

      Summary TableDemographic data for 394 patients with E. coli Urinary Tract Infection.
      Demographic data ESBL group Non-ESBL group
      (n = 98) (n = 294)
      Male gender (n, %) 28 (28.6) 42 (14.1)
       Uncircumcised (n, %) 24 (85.7) 26 (61.9)
      Median age (month, range) 46.5 (6–100) 55.5 (6–100)
      Race (n, %)
       White 61 (62.2) 205 (69.7)
       African American 29 (29.6) 88 (29.9)
       Asian 6 (6.1) 1 (0.3)
       Pacific Islander/Native American 2 (2) 0 (0)
      *For continuous variables, t test and Wilcoxon two-sample test are used.

      Keywords

      Abbreviations:

      CA (community acquired), ESBL (extended-spectrum β-lactamase), UTI (urinary tract infection), CFU (colony forming units), VUR (vesicoureteral reflux), PCI (pediatric comorbidity index), OR (odds ratio), CI (confidence interval), ICU (intensive care unit), NICU (neonatal intensive care unit)
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