Analysis of antibiotic resistance and risk factors of extended-spectrum beta-lactamases-producing Escherichia coli in hospitalized children with community-acquired urinary tract infections.

OBJECTIVE

The incidence of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli (E. coli) infections is rising. This study investigates the antibiotic resistance profiles and risk factors associated with ESBL-producing E. coli in urinary tract infections (UTIs) among hospitalized children, providing a basis for rational clinical management.

METHODS

We analyzed the clinical data of 140 children diagnosed with UTIs caused by E. coli at Anhui Provincial Children's Hospital from July 2021 and June 2024 in this retrospective study.

RESULTS

Among the 140 E. coli strains isolated, the male-to-female ratio was 1.75:1, with a median age of 7 months. Seventy-five strains (53.6%) were identified as ESBL producers. Non-ESBL-producing strains exhibited the highest resistance to ampicillin (60%) and lower resistance rates to cephalosporins and monobactams. Resistance rates for ampicillin-sulbactam, piperacillin-tazobactam, and cefoperazone-sulbactam were 29.2%, 6.2%, and 6.2%, respectively. No resistance to nitrofurantoin was observed, and only two strains were resistant to carbapenems. ESBL-producing strains demonstrated significantly higher resistance rates to most clinically relevant antimicrobials compared to non-producing strains. Among cephalosporins, resistance rates exceeded 90% for cefazolin, cefuroxime, and ceftriaxone, followed by cefepime (65.3%) and ceftazidime (29.3%). Notably, resistance to ampicillin-sulbactam was 50.7%, with greater sensitivity observed for cefoperazone-sulbactam and piperacillin-tazobactam. Resistance to cefotetan and nitrofurantoin remained low, and no carbapenem-resistant ESBL-producing strains were identified. Multifactorial logistic regression analysis indicated that abnormal urinary tract structure and a history of antibiotic treatment within the past 3 months were independent risk factors for UTIs caused by ESBL-producing E. coli (OR = 2.323, 95% CI = 1.052-5.129, P = 0.037 and OR = 3.378, 95% CI = 1.116-10.224, P = 0.031, respectively).

CONCLUSIONS

ESBL-producing E. coli infections in pediatric UTIs are very common in our hospital, with high resistance rates to many used antibiotics. Awareness of the risk factors-namely, abnormal urinary tract structure and recent antibiotic treatment-is essential for effective management. Empirical treatment should involve a rational selection of antimicrobials based on local bacterial resistance patterns.