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Children with underlying comorbidity, cystostomy at higher risk for ESBL-PB UTI

06 Mar 2020

Underlying comorbidities and cystostomy in children are associated with an increased risk of urinary tract infection (UTI) caused by extended-spectrum β-lactamase–producing bacteria (ESBL-PB), according to a recent study. However, most ESBL cases are those without any known risk factors.

This nested case-control study was conducted from 1 January 2012 through 31 December 2016. The investigators compared 240 paediatric patients with ESBL-PB UTI with 480 non-ESBL-PB UTI controls who were matched according to age and year of diagnosis.

Children with ESBP-PB UTI, compared with matched controls, were more likely to have a history of prior admission to the intensive care unit (ICU; 22.5 percent vs 12.3 percent; p<0.001), one or more underlying comorbidities (19.2 percent vs 5.8 percent; p<0.001), prior hospitalization (47.1 percent vs 32.9 percent; p<0.001), exposure to a cephalosporin antibiotic within 30 days before culture (7.5 percent vs 4.2 percent; p=0.035), and to have cystostomy (7.9 percent vs 1.5 percent; p<0.001).

In addition, hypothermia prevalence was higher (48.8 percent vs 38.5 percent; p=0.009) and average hospital stays were significantly longer (8.7 vs 4.0 days) in patients with ESBL-PB UTI. They were also more likely to be admitted to the ICU (odds ratio [OR], 1.8, 95 percent confidence interval [CI], 1.1–2.9).

In multivariate analysis, only having cystostomy (OR, 3.7, 95 percent CI, 1.4–9.4) and at least one underlying comorbidity (OR, 2.4, 95 percent CI, 1.3–4.3) independently predicted ESBL-PB UTI. All ESBL-PB isolates tested against meropenem were susceptible, and majority were resistant to multiple nonbeta-lactam antibiotics.

“Clinical signs/symptoms and commonly used biochemical markers were unreliable to differentiate cases caused by ESBL-PB from those caused by non-ESBL-PB,” the investigators said.

“Further research is needed to elucidate the conditions most associated with ESBL-PB UTIs among children to properly guide empirical therapy in patients at-risk for these infections, to improve the outcomes and … to determine strategies for rational antimicrobial use,” they added.

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Most Read Articles
Jairia Dela Cruz, 22 Apr 2020
A wristwatch-like device that monitors pulse, breathing and blood oxygen levels of the user allows physicians to provide care remotely both in hospital and nontraditional settings, and may help in the fight against the coronavirus disease 2019 (COVID-19) pandemic.
Roshini Claire Anthony, 6 days ago

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