Risk Factors in Cases of ESBL-Positive E. coli Isolated from Urine Cultures in Community-Acquired Urinary Tract Infections in Children

INTRODUCTION: Extended-spectrum β-lactamase (ESBL)-producing Escherichia (E.) coli has become an increasing concern in pediatric community-acquired urinary tract infections (UTIs). The primary aim of this study is to investigate and identify the clinical, demographic, and medical history-related risk factors associated with ESBL-producing E. coli strains isolated from urine cultures of pediatric patients diagnosed with community-acquired UTIs.
METHODS: We retrospectively reviewed 100 pediatric patients with ESBL-positive E. coli UTIs hospitalized between 2008–2012, all of whom received meropenem therapy. Risk factors, clinical manifestations, urine collection methods, comorbidities, and prior antibiotic exposure were collected.
RESULTS: ESBL-positive E. coli UTIs were more frequent in boys during the neonatal period but became predominant in girls thereafter, with the highest prevalence under two years of age. Clinical manifestations vary with age, ranging from nonspecific symptoms such as fever and vomiting in infants to typical complaints like abdominal pain and dysuria in older children. E. coli was identified as the leading pathogen, while high resistance rates to commonly used antibiotics (ampicillin, amoxicillin/clavulanate, TMP-SMX) were observed. Carbapenems remained the most effective agents, though their use should be reserved due to cost and hospitalization requirements. Underlying urinary tract abnormalities, vesicoureteral reflux, recurrent infections, and recent antibiotic exposure were major risk factors for ESBL (+) UTIs.
DISCUSSION AND CONCLUSION: Our results highlight the clinical significance of ESBL-producing E. coli in pediatric UTIs. Early recognition of risk factors, careful diagnostic evaluation, and rational antibiotic selection are crucial for optimal management.