All issues > Volume 47(2); 2004

Original Article

Korean J Pediatr. 2004;47(2):164-169. Published online February 15, 2004.

Risk Factors of Urinary Tract Infections Due to Extended-spectrum β-lactamase Producing Escherichia coli in Children

Nam Hee NH Kim¹, Jin A JA Lee¹, Yun Kyung YK Kim¹, Eun Hwa EH Choi¹, Il Soo IS Ha¹, Hoan Jong HJ Lee¹, Yong Y Choi¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence Hoan Jong HJ Lee ,Email: hoanlee@plaza.snu.ac.kr

Abstract

Purpose
: This study was performed to identify risk factors for urinary tract infection(UTI) by extended-spectrum β-lactamase(ESBL)-producing Escherichia coli in children.
Methods
: We analyzed 125 episodes of UTI which were developed in 112 children at the Seoul National University Children's Hospital from July to December 2002. Medical records of 74 episodes of UTI caused by E. coli were reviewed in a search for possible risk factors of infection by ESBL producers. The presence of ESBL in E. coli was screened and confirmed by the National Committee for Clinical Laboratory Standards guidelines and/or double disk synergy test.
Results
: The most common isolates were E. coli(74 isolates), followed by Enterobacter spp.(nine isolates) and Klebsillea spp.(eight isolates). Fifteen isolates were gram positive microorganisms. The prevalence of ESBL producers among 74 strains of E. coli was 18%(13 isolates). Previous hospitalization within six months(P=0.001; odds ratio[OR], 8.72, 95% confidence interval[CI], 1.87 to 40.6) and prior use of extended-spectrum cephalosporins within a month(P=0.009; OR,10.94, 95% CI, 1.59 to 75.4) were associated with the increased risk of UTI by ESBL-producing E. coli. However, age, sex, and the underlying urogenital anomalies did not contribute to the development of UTI by ESBL- producing E. coli.
Conclusion
: ESBL-producing strains of E. coli have been increasingly recognized in pediatric UTI. Previous use of antibiotics was related to the risk of infection by ESBL-producers. Therefore, prudent use of antibiotics should be recommended for antimicrobial therapy in children.

Keywords :Extended spectrum β-lactamase, Escherichia coli, Urinary tract infection