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Submitted: 04 Oct 2020
Accepted: 02 Aug 2021
ePublished: 26 Aug 2021
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J Renal Inj Prev. 2022;11(1): e2-e2.
doi: 10.34172/jrip.2022.02
  Abstract View: 413
  PDF Download: 249

Original

Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics

Manijeh Kahbazi 1 * ORCID logo, Parsa Yousefichaijan 2 ORCID logo, Danial Habibi 3 ORCID logo, Somaie Nejabat 4 ORCID logo, Amirreza Najmi 1 ORCID logo, Fateme Karimi 1 ORCID logo

1 Infectious Disease Research Center (IDRC), Arak University of Medical Sciences, Arak, Iran
2 Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
3 Department of Biostatistics and Epidemiology, Arak University of Medical Sciences, Arak, Iran
4 Students Research Committee, Arak University of Medical Sciences, Arak, Iran
*Corresponding author: Manijeh Kahbazi, Email: m_kahbazi77@yahoo.com, Dr.kahbazi@arakmu.ac.ir

Abstract

Introduction: The prevalence of urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL)-producing bacteria is rising, which needs more potent antibiotics, such as carbapenems.

Objectives: To evaluate the clinical and laboratory differences between ESBL-positive and ESBL-negative bacteria in febrile UTI in children between one month to seven years to indicate prognostic parameters for ESBL+ UTI and to suggest appropriate antibiotic treatment.

Patients and Methods: This cross-sectional study investigated 282 patients diagnosed with the first febrile UTI. The participants were assigned to ESBL-positive and ESBL-negative UTI groups. The groups were compared based on their clinical and laboratory characteristics and outcomes; the infant group was assessed separately (with the onset age of <3 months).

Results: The ESBL UTI was detected in 10.2% of the cases with a history of more frequent hospitalization (P=0.002), longer hospitalization (P=0.04), higher recurrence rate (P=0.003), and more red blood cell count in urine analysis findings (P=0.02). In the antimicrobial susceptibility assay, the ESBL-positive UTI group indicated resistance to third-generation cephalosporins; nevertheless, 93.1% of the cases responded clinically. The infant group showed 13% of the patients with ESBL-positive UTI that was correlated with a history of longer preonset hospital stay (P=0.001), elevated C-reactive protein (CRP) concentration (P=0.002), and elevated recurrence rate (P=0.03), compared to the older group.

Conclusion: The ESBL UTI should be further considered due to the resulted recurrence rate. The antimicrobial sensitivity assay indicated resistance to third-generation cephalosporins; however, these drugs are applied as the first choice due to the high response rate. Aminoglycosides are applicable as second choice drugs prior to initiating the use of carbapenems, if third-generation cephalosporins did not indicate bactericidal impacts on ESBL UTI.


Keywords: Cephalosporin, Extended-spectrum β-lactamase, Urinary tract infection, Age

Implication for health policy/practice/research/medical education:

In a cross-sectional study on 282 children, we evaluated the clinical and laboratory significance of extended-spectrum β-lactamase (ESBL) urinary tract infection (UTI) in children who were diagnosed with their first febrile infection. Patients were divided into ESBL+ and ESBL groups. ESBL+ occurred in 10.2% of patients who had more frequent previous hospitalization, duration of hospitalization and higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins among ESBL-positive UTI. ESBL+ UTI requires more attention because of its high recurrence rate and antibiotic resistance.

Please cite this paper as: Kahbazi M, Yousefichaijan P, Habibi D, Nejabat S, Najmi A, Karimi F. Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics. J Renal Inj Prev. 2022; 11(1): e02. doi: 10.34172/jrip.2022.02.


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