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. 2022 Jul 1;150(1):e2021051468.
doi: 10.1542/peds.2021-051468.

Treatment and Epidemiology of Third-Generation Cephalosporin-Resistant Urinary Tract Infections

Shom Dasgupta-Tsinikas  1   2 , Kenneth M Zangwill  1   3 , Katherine Nielsen  4 , Rebecca Lee  4 , Scott Friedlander  3 , Suzanne M Donovan  5 , Tam T Van  6 , Susan M Butler-Wu  7 , Jagmohan S Batra  8 , Sylvia H Yeh  1   3 ; Resistant UTI in Children Study Team
Affiliations

Treatment and Epidemiology of Third-Generation Cephalosporin-Resistant Urinary Tract Infections

Shom Dasgupta-Tsinikas et al. Pediatrics. .

Abstract

Background and objectives: Limited data are available on the contemporary epidemiology, clinical management, and health care utilization for pediatric urinary tract infection (UTI) due to third-generation cephalosporin-resistant Enterobacterales (G3CR) in the United States. The objective is to describe the epidemiology, antimicrobial treatment and response, and health care utilization associated with G3CR UTI.

Methods: Multisite, matched cohort-control study including children with G3CR UTI versus non-G3CR UTI. UTI was defined as per American Academy of Pediatrics guidelines, and G3CR as resistance to ceftriaxone, cefotaxime, or ceftazidime. We collected data from the acute phase of illness to 6 months thereafter.

Results: Among 107 children with G3CR UTI and 206 non-G3CR UTI with documented assessment of response, the proportion with significant improvement on initial therapy was similar (52% vs 57%; odds ratio [OR], 0.81; 95% confidence interval [CI], 0.44-1.50). Patients with G3CR were more frequently hospitalized at presentation (38% vs 17%; OR, 3.03; 95% CI, 1.77-5.19). In the follow-up period, more patients with G3CR had urine cultures (75% vs 53%; OR, 2.61; 95% CI, 1.33-5.24), antimicrobial treatment of any indication (53% vs 29%; OR, 2.82; 95% CI, 1.47-5.39), and subspecialty consultation (23% vs 6%; OR, 4.52; 95% CI, 2.10-10.09). In multivariate analysis, previous systemic antimicrobial therapy remained a significant risk factor for G3CR UTI (adjusted OR, 1.91; 95% CI, 1.06-3.44).

Conclusions: We did not observe a significant difference in response to therapy between G3CR and susceptible UTI, but subsequent health care utilization was significantly increased.

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Conflict of interest statement

Potential Conflicts of Interest: The authors have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1:
FIGURE 1:
Flow diagram for cohort-control study of pediatric UTI due to third-generation cephalosporin-resistant Enterobacterales. ASB, asymptomatic bacteriuria. cfu/mL, colony-forming units per milliliter. CRE, carbapenem-resistant Enterobacterales. G3CR, third-generation cephalosporin-resistant. UA(−), urinalysis criterion not fulfilled. UTI, urinary tract infection.
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References

    1. Basmaci R, Vazouras K, Bielicki J, et al. Urinary Tract Infection Antibiotic Trial Study Design: A Systematic Review. Pediatrics. 2017;140(6):e20172209. doi:10.1542/peds.2017-2209 - DOI - PubMed
    1. Copp HL, Shapiro DJ, Hersh A. National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998 – 2007. Pediatrics. 2011;127(6):1027–1033. doi:10.1542/peds.2010-3465 - DOI - PMC - PubMed
    1. Watson JR, Sánchez PJ, Spencer JD, Cohen DM, Hains DS. Urinary Tract Infection and Antimicrobial Stewardship in the Emergency Department. Pediatr Emerg Care. 2018;34(2):2016–2018. doi:10.1097/PEC.0000000000000688 - DOI - PubMed
    1. Al-sayyed B, Le J, Al-tabbaa MM, Barnacle B, Ren J. Uncomplicated Urinary Tract Infection in Ambulatory Primary Care Pediatrics: Are We Using Antibiotics Appropriately? J Pediatr Pharmacol Ther. 2019;24(1):39–44. doi:10.5863/1551-6776-24.1.39 - DOI - PMC - PubMed
    1. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and 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. Pediatrics. 2011;128(3):595–610. doi:10.1542/peds.2011-1330 - DOI - PubMed

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