Risk Factors for Community acquired Pediatric Urinary Tract Infection with Extended-spectrum-β-lactamase E. coli - A case-control study
Joshua D. Collingwood, B.S.1, Lingling Wang, M.S.2, Inmaculada B. Aban, Ph.D.2, April H. Yarbrough, Pharm. D., BCPS3, Suresh B. Boppana, M.D.3, Pankaj P. Dangle, M.D.3.
1Alabama College of Osteopathic Medicine, Dothan, AL, USA, 2University of Alabama, Birmingham, AL, USA, 3Children's Hospital of Alabama, Birmingham, AL, USA.
Background: Community-acquired (CA) infections caused by extended-spectrum beta-lactamase-producing gram-negative bacilli (ESBL-GNB) have become increasingly prevalent, posing a serious threat to public health. Risk factors for ESBL-GNB urinary tract infections (UTI) have not been extensively studied in the pediatric population. We report findings from a case control study to identify risk factors for CA ESBL-GNB UTI in children.
Methods: A cohort of children with CA ESBL Escherichia coli UTI evaluated at a tertiary referral hospital from 2013 through April 2021, were matched 1:3 with control group of non-ESBL CA E. coli UTI based on age at first episode of non-ESBL UTI. To identify potential risk factors for ESBL-GNB E. coli UTI, conditional logistic regression model was utilized accounting for age matching. Univariate models were fitted for each clinical risk factor. Factors found to be significantly associated with ESBL UTI were simultaneously included in a single model to check for associations adjusted for all other factors.
Results: The cohort included 392 children with CA E. coli UTI (98 children with ESBL UTI and 294 with non-ESBL UTI). The median age was 11.78 months (0.1-94.63) and 82% were female. Logistic regression identified male sex (OR: 2.53; 95% CI: 1.43, 4.50; P=0.002), hydronephrosis (OR: 2.66; 95% CI: 1.34, 5.26; P=0.005), vesicoureteral reflux (VUR) (OR: 2; 95% CI: 1.04, 3.84; P=0.037), and prior Urology care (OR: 4.17; 95% CI: 2.23, 7.80; P<.001) as significant risk factors for ESBL E. coli UTI. Children with an underlying renal abnormality (OR: 1.79; 95% CI: 1.05, 3.05; P=0.033), history of previous hospitalization (OR: 3.26; 95% CI: 1.95, 5.46; P<0.001) or intensive care unit (ICU) admission (OR: 3.74; 95% CI: 1.64, 8.57; P=0.002), as well as have been hospitalized (OR: 3.41; 95% CI: 1.86, 6.26; P<0.001), underwent surgery (OR: 3.49; 95% CI: 1.44, 8.47; P=0.006), or received antibiotics (OR: 4.37; 95% CI: 2.16, 8.81; P<0.001) within 30 days prior to positive culture were more likely to have ESBL UTI.
On multivariate analyses, male sex (OR: 2.23; 95% CI: 1.13, 4.40; P=0.021), history of Urology care (OR: 4.46; 95% CI: 1.82, 10.9; P=0.001), and antibiotic treatment within 30 days prior to positive culture (OR: 3.96; 95% CI: 1.55, 10.12; P=0.004) remained as significant risk factors for ESBL E. coli UTI.
Comorbidity scores were assigned to each patient according to pediatric comorbidity index (PCI); children with ESBL UTI were more likely to have higher morbidity risk than non-ESBL UTI children (6.01 ± 6.94 vs. 3.05 ± 4.74; P<0.001). From the logistic model, the higher the morbidity scores, the more likely children will have ESBL UTI (OR: 1.09; 95% CI: 1.05, 1.13; P<0.001).
Conclusions: Findings from our case-control study suggest that the male sex, history of Urology care, and previous antibiotic exposure are independent risk factors for CA ESBL-GNB UTI. 
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