- 作者：Noam Dayan ; Husein Dabbah ; Irith Weissman ; Ibrahim Aga ; Lea Even ; Daniel Glikman
- 关键词：AAP ; American Academy of Pediatrics ; CA ; Community-acquired ; ESBL ; Extended-spectrum 尾-lactamase ; Trimet/Sulfa ; Trimethoprim-sulfamethoxazole ; UTI ; Urinary tract infection ; WGH ; Western Galilee Hospital
- 刊名：The Journal of Pediatrics
- 出版年：November, 2013
- 年：2013
- 卷：163
- 期：5
- 页码：1417-1421
- 全文大小：344 K
Objective
To study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum 尾-lactamase (CA-ESBL)-producing Enterobacteriaceae.Study design
A case-control study at a large community hospital in northern Israel, comparing children who had UTI due to CA-ESBL (n = 25) and CA non-ESBL (n = 125) in 2008-2011. Data were collected from medical charts, telephonic questionnaires administered to all participants, and groups were compared.
Results
During the study period, the yearly incidence of CA-ESBL UTI increased significantly. There were no significant differences between the CA-ESBL and CA non-ESBL groups in demographics and clinical outcome. Compared with CA non-ESBL UTI, children with CA-ESBL UTI had a longer hospital stay (5.9 卤 3.3 vs 3.9 卤 2.3 days; P = .003) and higher rates of recent hospitalization (28% vs 4%; P = .001), previous UTI (40% vs 13%; P聽=聽.003), urinary tract anomalies (32% vs 5%; P < .001), UTI prophylaxis with cephalexin (32% vs 2%; P聽<聽.005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent聽hospitalization (OR 4.8 [CI 1.1-21]), and Klebsiella spp. UTI (OR 4.7 [CI 1.3-17]), were risk factors for CA-ESBL UTI.
Conclusions
Children prescribed UTI prophylaxis (due to urinary tract anomalies or recurrent UTI) with cephalexin and those with previous hospitalizations are at increased risk for CA-ESBL UTI. Although not associated with higher rates of complications, the multidrug resistant phenotype of CA-ESBL isolates poses a challenge in choosing appropriate empiric and definitive therapy and prolongs hospital stay.