Prevalence of urinary tract infections caused by extended-spectrum β-lactamase (ESBL)-producing organisms in children at a community hospital: a retrospective study.

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ESPR134
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BACKGROUND: Extended spectrum beta lactamase (ESBL)-producing organisms are on the rise and pose a growing threat to public health. Infections due to ESBL-producing organisms are hard to treat and have been associated with worse outcomes. A previous study performed in our own institution, showed high rates of E. Coli resistance to penicillins. High rates of resistance have also been observed with amikacin and gentamicin, and the frequent use of carbapenems is now giving way to carbapenemase-producing organisms. International literature reports a prevalence of ESBL-producing organisms in pediatric UTI cases of up to 14%.  This study was undertaken to investigate if there is an increase in community-acquired UTIs associated with ESBL-producing organisms within our patient population.

OBJECTIVE: To determine the prevalence and outcomes of community-acquired ESBL UTIs in children presenting to an inner-city community hospital. 

METHODS: A retrospective cross-sectional study was performed using data from records of patients between 3 months and 18 years of age with a positive urine cultures between 2010 and 2018 in the outpatient and inpatient settings. The primary outcome of interest was to establish the prevalence of ESBL. A linear regression was also performed to observe for a trend in incidence. A univariate analysis was performed on admission and length-of-stay among ESBL and non-ESBL groups.   

RESULTS: Of a total of 1874 positive urine cultures, there were 49 ESBL isolates representing 2.6% of the sample. All ESBL cases were due to E. Coli except for one case of Klebsiella oxytoca. Most ESBL infections occurred in adolescents (n=20, 40.8%) and in females (n=41, 83.7%) (Table 1). No significant yearly incidence increase was observed as illustrated by a linear regression (R2 = 0.3163). The admission rate of ESBL cases (16.3%) was similar to that of the non-ESBL group (19.7%). There was no increased risk of hospitalization among the ESBL cases compared to non-ESBL (OR=0.79, CI 0.37 - 1.71, p= 0.55). The average length-of-stay (LOS) in admitted patients was the same in the ESBL and the non-ESBL group (1.2 days). However, ESBL cases were more likely to have a LOS of 10 or more days (OR=7.72, CI 1.65-36.23, p=0.009).

CONCLUSIONS: This study reports a low overall prevalence of ESBL-producing organisms in pediatric community-acquired UTIs in an inner-city hospital in the Bronx. An anecdotal yearly increase of ESBL cases had been reported in our institution, however our analysis showed no significant upward trend in the years studied. Infection with an ESBL-producer was associated increased likelihood of LOS ≥ 10 days. While ESBL infections were initially mostly attributed to nosocomial sources, their current prevalence in the community setting is of concern.

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BronxCare Health System
American University of the Caribbean School of Medicine
BronxCare Health System

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