Extended spectrum beta lactamase (ESBL) producing bacteria urinary tract infections and complex pediatric urology

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• 作者：Ruth Wragg^a ; Anna Harris^a ; Mitul Patel^b ; Andrew Robb^a ; Harish Chandran^a ; Liam McCarthy^a ; ^{liam.mccarthy@bch.nhs.uk}
• 关键词：ESBL ; Antibiotic resistance ; Urinary tract abnormality ; Urinary tract infection ; Antibiotic stewardship
• 刊名：Journal of Pediatric Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：52
• 期：2
• 页码：286-288
• 全文大小：176 K
• 卷排序：52

文摘

Extended spectrum beta lactamase (ESBL) producing bacteria are resistant to most beta-lactam antibiotics including third-generation cephalosporins, quinolones and aminoglycosides. This resistance is plasmid-borne and can spread between species. Management of ESBL is challenging in children with recurrent urinary tract infections (UTIs) and complex urological abnormalities. We aim to quantify the risk in children and specifically in urological patients.MethodsRetrospective review of a microbiology database (April 2014 to November 2015). This identified urine isolates, pyuria, ESBL growth and patient demographics. Data analysis was by Chi square, Mann–Whitney U-test and ANOVA. A P value of < 0.05 was taken as significant.Main resultsAnalysis of 9418 urine samples showed 2619 with pure isolates, of which 1577 had pyuria (> 10 × 106 WC/L). 136 urine cultures (n = 79 patients) grew purely ESBL. Overall, 5.2% of urine isolates were ESBL and 9.5% isolates with pyuria (> 100 × 106 WC/L) had ESBL, whereas only 22/1032 (2.1%) with no pyuria, (P < 0.0001).Urology patients had 86/136 (63%) ESBL positive cultures. These represented 86/315 (27%) of all positive cultures for urology patients vs. 50/2267 (2.2%) for all other specialties (P < 0.0001). Potential ESBL transmission between organisms occurred in 3 (all on prophylactic antibiotics).Over the study period, there was no significant rise of the monthly incidence between 2014 and 2015 (ANOVA P = 0.1).ConclusionThis study is the first to document the incidence of ESBL in children (5%), and estimate the frequency of possible plasmid transmission between bacterial species in children. This quantifies the risk of ESBL, especially to urology patients, and mandates better antibiotic stewardship.Level of evidenceLevel IIc.