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 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 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. 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
