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J Pediatr Pharmacol Ther. 2015 Sep-Oct;20(5):373-7. doi: 10.5863/1551-6776-20.5.373.

Extended-Spectrum Beta-Lactamase Bacteria From Urine Isolates in Children.

Author information

1
Department of Pharmacy, Jersey Shore Medical Center, Neptune, New Jersey.
2
Division of Pediatric Infectious Diseases, Department of Pediatrics ; Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland.
3
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
4
Division of Pediatric Infectious Diseases, Department of Pediatrics ; Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.

Abstract

OBJECTIVES:

Multidrug-resistant Gram-negative bacteria, including extended-spectrum beta-lactamase (ESBL)-producing organisms, are a growing problem. The primary objective of this study was to describe the proportion of children with ESBL-producing urinary isolates at a tertiary medical center as well as these organisms' susceptibility patterns. The secondary objective was to identify the risk factors for acquiring ESBL urinary pathogens.

METHODS:

This retrospective study evaluated a cohort of children with ESBL urinary isolates, admitted to a tertiary children's hospital during a 6-year period. The proportion of patients with an ESBL-producing urinary isolate among all patients who grew a Gram-negative isolate is described together with the organism's susceptibility pattern. Patients with non-ESBL Gram-negative urinary organisms were used as a control group for identifying patient risk factors for ESBL.

RESULTS:

A total of 7.8% (29 of 370) of patients in our cohort grew Gram-negative urinary isolates with an ESBL strain. Most of the ESBL organisms isolated were sensitive to carbapenems (100% of ESBL organisms susceptible to ertapenem and 93.8% susceptible to meropenem) and amikacin (92.3% of ESBL organisms susceptible). Patients with longer hospitalization, recent antibiotic use, and recent intensive care unit admission were found to be at increased risk for ESBL organisms in the urine.

CONCLUSIONS:

When selecting empiric antibiotic therapy for suspected urinary tract infection in children, it may be prudent to consider the risk factors identified for acquiring an ESBL urinary pathogen.

KEYWORDS:

extended-spectrum beta-lactamase; pediatric; urinary

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