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Communitiy-acquired urinary tract infections by extended-spectrum beta-lactamase-producing Escherichia coli in children: clinical and molecular characteristics

Abstract number: 902_p1881

Lee M.A.

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Objectives:

Recently our institution noted a marked increase in the number of ESBL (extended-spectrum beta-lactamase)-producing E. coli isolated from children with urinary tract infections (UTI). The children were ambulatory patients or had been seen in the emergency department. The purpose of this study was to investigate clinical and molecular characteristics of ESBL-producing E. coli from community-acquired UTI in children.

Methods:

We analysed 36 children with UTI due to ESBL-producing E. coli (cases) and 58 children with UTI due to non-ESBL-producing E. coli (controls) in Ewha Womans University Hospital from July 2001 to June 2002.

Results:

Of the total 1136 E. coli isolates from urine, 119 (10.5%) produced ESBL and the prevalence of UTI due to ESBL-producing E. coli was higher in children (19.3%) than in adults (4.6%). Case patients had significantly higher resistance to aztreonam, ceftriaxone, cefotaxime, cefepime, and ceftazidime than control patients (P < 0.05). Case patients were younger (4 ± 1 months) than control patients (24 ± 76 months) and were more frequently male (30of 36) than control patients (39 of 58). No significant differences were noted in prior UTI, prior antibiotic use, genitourinary abnormality, vesicoureteral reflux, urinary catheter, pyelonephritis or underlying diseases between cases and controls (P < 0.05). No significant difference in cure rate was noted between both groups, but case patients had a significantly higher relapse rate (41.7%) than control patients (2.1%, P < 0.05). Of the 27 strains analysed by PCR, 23 strains produced TEM, three produced TEM and SHV, and one produced SHV. Pulsed-field gel electrophoresis of 24 ESBL-producing organisms showed 18 distinct genotypes including five clusters.

Conclusions:

ESBL-producing E. coli may be a causative agent of community-acquired UTI in children without any specific risk factors. Most strains were genetically unrelated and these findings suggested as community-acquired infection through dissemination of plasmids rather than the clonal spread.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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