Urinary Tract Infections Caused by Community-Acquired Extended-Spectrum b-Lactamase-Producing and Nonproducing Bacteria: A Comparative Study

Objective To study the clinical characteristics and associated risk factors of urinary tract infections (UTIs) caused by community-acquired extended-spectrum b-lactamase (CA-ESBL)-producing Enterobacteriaceae. Study design A case-control study at a large community hospital in northern Israel, comparing children who had UTI due to CA-ESBL (n = 25) and CA non-ESBL (n = 125) in 2008-2011. Data were collected from medical charts, telephonic questionnaires administered to all participants, and groups were compared. Results During the study period, the yearly incidence of CA-ESBL UTI increased significantly. There were no significant differences between the CA-ESBL and CA non-ESBL groups in demographics and clinical outcome. Compared with CA non-ESBL UTI, children with CA-ESBL UTI had a longer hospital stay (5.9 +/- 3.3 vs 3.9 +/- 2.3 days; P =.003) and higher rates of recent hospitalization (28% vs 4%; P =.001), previous UTI (40% vs 13%; P =.003), urinary tract anomalies (32% vs 5%; P <.001), UTI prophylaxis with cephalexin (32% vs 2%; P <.005), and aminoglycoside resistance. In a multivariate analysis, UTI prophylaxis (OR 12.5 [CI 2.7-58]), recent hospitalization (OR 4.8 [CI 1.1-21]), and Klebsiella spp. UTI (OR 4.7 [CI 1.3-17]), were risk factors for CA-ESBL UTI. Conclusions Children prescribed UTI prophylaxis (due to urinary tract anomalies or recurrent UTI) with cephalexin and those with previous hospitalizations are at increased risk for CA-ESBL UTI. Although not associated with higher rates of complications, the multidrug resistant phenotype of CA-ESBL isolates poses a challenge in choosing appropriate empiric and definitive therapy and prolongs hospital stay.