Extended-spectrum beta-lactamase-producing gram-negative urinary tract infections in children: A retrospective children’s hospital experience
Abstract
Objective: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are an increasing concern in pediatric urinary tract infections (UTIs), contributing to antimicrobial resistance, limited treatment options, and higher recurrence rates. This study aimed to identify the risk factors associated with ESBL-positive Gram-negative UTIs in children and evaluate antimicrobial susceptibility patterns. Material and Methods: Medical records of pediatric patients aged 1 month to 18 years with culture-confirmed ESBL-producing Gram-negative UTIs were retrospectively reviewed between January 2015 and December 2020 at a tertiary pediatric hospital in Istanbul. Both inpatient and outpatient cases were included. Data extracted from electronic records included demographic characteristics, clinical presentation, comorbidities, recent antibiotic use, prior hospitalization or surgery, intensive care unit (ICU) admission, use of urinary or central venous catheters, and total parenteral nutrition (TPN). Results: Among 4,722 positive pediatric urine cultures, ESBL-producing Gram-negative organisms were identified in 215 cases (4.6%). After applying the inclusion criteria, 184 patients were analyzed. The cohort showed a female predominance (80.4%), with a median age of 57 months. Presentations included cystitis (60.9%) and pyelonephritis (39.1%). Common risk factors were recent antibiotic use (44%) and prior hospitalization (12.5%). Antimicrobial susceptibility testing demonstrated high in vitro activity for meropenem, fosfomycin, and amikacin (>90%). No treatment failure or urosepsis occurred during the initial episode. Recurrent UTIs were observed in 10.3% of cases. Conclusion: ESBL-producing Gram-negative UTIs highlight the need for risk-based evaluation and antimicrobial stewardship. Fosfomycin and nitrofurantoin may be suitable oral options pending culture results, while meropenem remains effective for severe infections.