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Increasing pediatric urinary tract infections by extended spectrum-β-lactamase producing bacteria - Cause for concern
Joshua D. Collingwood, B.S.1, April H. Yarbrough, Pharm. D., BCPS2, Suresh B. Boppana, M.D.2, Pankaj P. Dangle, M.D.2.
1Alabama College of Osteopathic Medicine, Dothan, AL, USA, 2Children's Hospital of Alabama, Birmingham, AL, USA.

Background: Antimicrobial resistance and emerging extended-spectrum-β-lactamase (ESBL) infections is a rising concern in public health, limiting therapeutic options. We assessed the trend in ESBL UTIís at a tertiary pediatric hospital and antimicrobial resistance patterns associated with it over the past 5 years.
Methods: After IRB approval, 168 pediatric urine cultures (2015-2020) positive for ESBL E. coli were reviewed; annual percent change and total percent change in number of ESBL E. coli UTI cases were analyzed. Resistance patterns were assessed for all ESBL E. coli isolates during the study period.
Results: A total of 168 urine samples collected from 135 children (77, 57% males) with a median age of 82.6 Ī 74.7 months. There was a marked increase in pediatric ESBL E. coli urinary tract infections by 512% over 5 years with an average percent increase of 53% each year at our hospital.Antibiotic resistance patterns were assessed; 106 (59%) of isolates demonstrated resistance to Ciprofloxacin, 63 (35.2%) resistant to Gentamicin, 64 (35.8%) resistant to Tobramycin, 113 (63.13%) resistant to Trimethoprim Sulfamethoxazole, and 28 (15.64%) resistant to Nitrofurantoin. All ESBL E. coli isolates remained susceptible to Meropenem over 5 years.
Conclusion: These findings demonstrate an alarming increase in ESBL urinary tract infections in children. We also observed that a majority of isolates were resistant to at least 3 different classes of antibiotics. As ESBL UTI infections are associated with prolonged hospitalization and increased morbidity, our findings highlight the challenges in the management of the children with ESBL UTI.


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