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J Pediatr. 2013 Nov;163(5):1417-21. doi: 10.1016/j.jpeds.2013.06.078. Epub 2013 Aug 3.

Urinary tract infections caused by community-acquired extended-spectrum β-lactamase-producing and nonproducing bacteria: a comparative study.

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Department of Pediatrics, Western Galilee Hospital, Nahariya, Israel.



To study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing Enterobacteriaceae.


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.


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 ± 3.3 vs 3.9 ± 2.3 days; P = .003) and higher rates of recent hospitalization (28% vs 4%; P = .001), previous UTI (40% vs 13%; P = .003), urinary tract anomalies (32% vs 5%; P < .001), UTI prophylaxis with cephalexin (32% vs 2%; P < .005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent 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.


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.


AAP; American Academy of Pediatrics; CA; Community-acquired; ESBL; Extended-spectrum β-lactamase; Trimet/Sulfa; Trimethoprim-sulfamethoxazole; UTI; Urinary tract infection; WGH; Western Galilee Hospital

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