Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Febrile urinary tract infection in children: changes in epidemiology, etiology, and antibiotic resistance patterns over a decade

  • Suh, Woosuck (Departments of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Bi Na (Departments of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kang, Hyun Mi (Departments of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Yang, Eun Ae (Departments of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Rhim, Jung-Woo (Departments of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kyung-Yil (Departments of Pediatrics, College of Medicine, The Catholic University of Korea)
  • Received : 2020.04.29
  • Accepted : 2020.09.18
  • Published : 2021.06.15
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Abstract

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.

Keywords

References

  1. Marild S, Jodal U. Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 1998;87:549-52. https://doi.org/10.1080/08035259850158272
  2. Hellstrom A, Hanson E, Hansson S, Hjalmas K, Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child 1991;66:232-4. https://doi.org/10.1136/adc.66.2.232
  3. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008;27:302-8. https://doi.org/10.1097/INF.0b013e31815e4122
  4. Jakobsson B, Svensson L. Transient pyelonephritic changes on 99mTechnetium-dimercaptosuccinic acid scan for at least five months after infection. Acta Paediatr 1997;86:803-7. https://doi.org/10.1111/j.1651-2227.1997.tb08601.x
  5. Coulthard MG, Lambert HJ, Vernon SJ, Hunter EW, Keir MJ, Matthews JN. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: mixed retrospective and prospective audits. Arch Dis Child 2014;99:342-7. https://doi.org/10.1136/archdischild-2013-304428
  6. Finnell SM, Carroll AE, Downs SM, Subcommittee on urinary tract I. Technical report-diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics 2011;128:e749-70. https://doi.org/10.1542/peds.2011-1332
  7. Stein R, Dogan HS, Hoebeke P, Kocvara R, Nijman RJ, Radmayr C, et al. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015;67:546-58. https://doi.org/10.1016/j.eururo.2014.11.007
  8. Subcommittee on Urinary Tract Infection SCoQI, Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610. https://doi.org/10.1542/peds.2011-1330
  9. Montini G, Toffolo A, Zucchetta P, Dall'Amico R, Gobber D, Calderan A, et al. Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. BMJ 2007;335:386. https://doi.org/10.1136/bmj.39244.692442.55
  10. Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. Wayne (PA): Clinical Laboratory Standards Institute, 2015.
  11. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:26881.
  12. Lee KY. New insights for febrile urinary tract infection (acute pyelonephritis) in children. Child Kidney Dis 2016:37-44.
  13. Huh SM, Park BK, Kang HM, Rhim JW, Suh JS, Lee KY. Clinical implications of DMSA scan in childhood acute pyelonephritis. Child Kidney Dis 2017;21:107-13. https://doi.org/10.3339/jkspn.2017.21.2.107
  14. Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ 2016;352:i939.
  15. Lee DS, Choe HS, Lee SJ, Bae WJ, Cho HJ, Yoon BI, et al. Antimicrobial susceptibility pattern and epidemiology of female urinary tract infections in South Korea, 2010-2011. Antimicrob Agents Chemother 2013;57:5384-93. https://doi.org/10.1128/AAC.00065-13
  16. Saksena R, Nayyar C, Manchanda V. Six-year susceptibility trends and effect of revised Clinical Laboratory Standards Institute breakpoints on ciprofloxacin susceptibility reporting in typhoidal Salmonellae in a tertiary care paediatric hospital in Northern India. Indian J Med Microbiol 2016;34:520-5. https://doi.org/10.4103/0255-0857.195362
  17. Kim YA, Park YS, Youk T, Lee H, Lee K. Trends in South Korean antimicrobial use and association with changes in Escherichia coli resistance rates: 12-year ecological study using a nationwide surveillance and antimicrobial prescription database. PLoS One 2018;13:e0209580. https://doi.org/10.1371/journal.pone.0209580
  18. Saksena R, Gaind R, Sinha A, Kothari C, Chellani H, Deb M. High prevalence of fluoroquinolone resistance amongst commensal flora of antibiotic naive neonates: a study from India. J Med Microbiol 2018;67:481-8. https://doi.org/10.1099/jmm.0.000686
  19. Azap OK, Arslan H, Serefhanoglu K, Colakoglu S, Erdogan H, Timurkaynak F, et al. Risk factors for extended-spectrum beta-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect 2010;16:147-51. https://doi.org/10.1111/j.1469-0691.2009.02941.x
  20. Pitout JD, Nordmann P, Laupland KB, Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother 2005;56:52-9. https://doi.org/10.1093/jac/dki166
  21. Lee J, Pai H, Kim YK, Kim NH, Eun BW, Kang HJ, et al. Control of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a children's hospital by changing antimicrobial agent usage policy. J Antimicrob Chemother 2007;60:629-37. https://doi.org/10.1093/jac/dkm225
  22. Bantar C, Vesco E, Heft C, Salamone F, Krayeski M, Gomez H, et al. Replacement of broad-spectrum cephalosporins by piperacillin-tazobactam: impact on sustained high rates of bacterial resistance. Antimicrob Agents Chemother 2004;48:392-5. https://doi.org/10.1128/AAC.48.2.392-395.2004
  23. Abe Y, Inan-Erdogan I, Fukuchi K, Wakabayashi H, Ogawa Y, Hibino S, et al. Efficacy of non-carbapenem antibiotics for pediatric patients with first febrile urinary tract infection due to extended-spectrum beta-lactamase-producing Escherichia coli. J Infect Chemother 2017;23:517-22. https://doi.org/10.1016/j.jiac.2017.04.006
  24. Lee B, Kang SY, Kang HM, Yang NR, Kang HG, Ha IS, et al. Outcome of antimicrobial therapy of pediatric urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Infect Chemother 2013;45:415-21. https://doi.org/10.3947/ic.2013.45.4.415
  25. Xu Y, Gu B, Huang M, Liu H, Xu T, Xia W, et al. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000-2012 in Asia. J Thorac Dis 2015;7:376-85. https://doi.org/10.3978/j.issn.2072-1439.2014.12.33
  26. Khatri A, Naeger Murphy N, Wiest P, Osborn M, Garber K, Hecker M, et al. Community-acquired pyelonephritis in pregnancy caused by KPC-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 2015;59:4375-8. https://doi.org/10.1128/AAC.00553-15
  27. Logan LK, Weinstein RA. The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis 2017;215:S28-36. https://doi.org/10.1093/infdis/jiw282