Cargando…
Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade
BACKGROUND: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. PURPOSE: This study aimed to analyze the epidemiolo...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Pediatric Society
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8181017/ https://www.ncbi.nlm.nih.gov/pubmed/33076637 http://dx.doi.org/10.3345/cep.2020.00773 |
_version_ | 1783704050727911424 |
---|---|
author | Suh, Woosuck Kim, Bi Na Kang, Hyun Mi Yang, Eun Ae Rhim, Jung-Woo Lee, Kyung-Yil |
author_facet | Suh, Woosuck Kim, Bi Na Kang, Hyun Mi Yang, Eun Ae Rhim, Jung-Woo Lee, Kyung-Yil |
author_sort | Suh, Woosuck |
collection | PubMed |
description | BACKGROUND: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. PURPOSE: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. METHODS: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006–2016. Electronic medical records were analyzed and radiologic images were evaluated. RESULTS: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0–10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0–2 months, 2.1:1 for those 3–5 months, and 1.6:1 for those 6–11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). CONCLUSION: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR. |
format | Online Article Text |
id | pubmed-8181017 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Korean Pediatric Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-81810172021-06-07 Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade Suh, Woosuck Kim, Bi Na Kang, Hyun Mi Yang, Eun Ae Rhim, Jung-Woo Lee, Kyung-Yil Clin Exp Pediatr Original Article BACKGROUND: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. PURPOSE: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. METHODS: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006–2016. Electronic medical records were analyzed and radiologic images were evaluated. RESULTS: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0–10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0–2 months, 2.1:1 for those 3–5 months, and 1.6:1 for those 6–11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). CONCLUSION: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR. Korean Pediatric Society 2020-10-14 /pmc/articles/PMC8181017/ /pubmed/33076637 http://dx.doi.org/10.3345/cep.2020.00773 Text en Copyright © 2021 by The Korean Pediatric Society https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Suh, Woosuck Kim, Bi Na Kang, Hyun Mi Yang, Eun Ae Rhim, Jung-Woo Lee, Kyung-Yil Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
title | Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
title_full | Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
title_fullStr | Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
title_full_unstemmed | Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
title_short | Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
title_sort | febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8181017/ https://www.ncbi.nlm.nih.gov/pubmed/33076637 http://dx.doi.org/10.3345/cep.2020.00773 |
work_keys_str_mv | AT suhwoosuck febrileurinarytractinfectioninchildrenchangesinepidemiologyetiologyandantibioticresistancepatternsoveradecade AT kimbina febrileurinarytractinfectioninchildrenchangesinepidemiologyetiologyandantibioticresistancepatternsoveradecade AT kanghyunmi febrileurinarytractinfectioninchildrenchangesinepidemiologyetiologyandantibioticresistancepatternsoveradecade AT yangeunae febrileurinarytractinfectioninchildrenchangesinepidemiologyetiologyandantibioticresistancepatternsoveradecade AT rhimjungwoo febrileurinarytractinfectioninchildrenchangesinepidemiologyetiologyandantibioticresistancepatternsoveradecade AT leekyungyil febrileurinarytractinfectioninchildrenchangesinepidemiologyetiologyandantibioticresistancepatternsoveradecade |