Risk factors for community acquired urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing in children: a case control study.

We noted a recent increase in cases of urinary tract infection due to community-acquired ESBL-producing in children treated at our institution. Risk factors of urinary tract infection due to ESBL-producing in children in the USA remain unclear. A single center retrospective case control study of UTI due to CA-ESBL-producing during a 5-year period (2012-2016). Control cases with non-ESBL-producing urinary tract infection were matched by age, gender and year of infection. A total of 111 patients with ESBL-producing urinary tract infection and 103 controls were included. The proportion of ESBL-producing urinary tract infection ranged from 7% to 15% of all UTI cases. The distribution of ESBL cases per year: 27 in 2012; 18 in 2013; 22 in 2014; 15 in 2015 and 29 in 2016. Median age was 4 years with female predominance (84%). The ESBL group was predominantly African American (32%) followed by individuals of Middle Eastern ethnic background (31%). Risk factors by univariate analysis were vesicoureteral reflux: (20.9 ESBL group vs 6% controls;  = .002), prior antibiotic usage in the last 3 months (including β-lactams), prior UTI (last 3 months), recent hospitalization (last 3 months) and Middle Eastern ethnic background. However, multivariate analysis showed that only prior antibiotic usage ( = .001) and Middle Eastern ethnic background ( < .001) were independent risk factors. ESBL-producing strains were more frequently resistant to trimethoprim-sulfamethoxazole (72% vs 25%) and ciprofloxacin (73% vs 5%) than strains not producing ESBL. Risk factors for community-acquired ESBL-producing urinary tract in our pediatric patient population were antibiotic usage within the previous 3 months and Middle Eastern ethnic background. This may be related to increased risk of intestinal colonization with resistant bacterial strains.