RESUMO
INTRODUCCIÓN: El objetivo de nuestro estudio fue investigar la presencia, las características clínicas y los factores de riesgo para la adquisición de infección urinaria febril/pielonefritis (ITU/PNA) de la comunidad por microorganismos productores de betalactamasas de espectro extendido (BLEE+) en niños < 2 años que fueron ingresados en el hospital. MÉTODOS: Estudio de casos-controles en un hospital de segundo nivel en España. Se revisaron de forma retrospectiva 537 episodios de ITU/PNA entre noviembre de 2005 y agosto de 2014. Los casos fueron las ITU/PNA BLEE+. Por cada caso se escogieron 4 controles betalactamasas de espectro extendido negativos (BLEE−). Para cada paciente se rellenó un cuestionario con las variables de interés y se realizó la comparación entre los grupos. RESULTADOS: Se identificaron 19 casos (3,5%) BLEE+. De ellos, 16 (84%) fueron Escherichia coli. El reflujo vesicoureteral (RVU) de cualquier grado fue más frecuente en el grupo BLEE+ (60 vs. 29%), aunque la diferencia no alcanzó significación estadística. Las recurrencias fueron más frecuentes en el grupo BLEE+ (42% vs 18%) (p = 0,029; OR = 3,2; IC-95%: 1,09-9,5). La prevalencia de ITU/PNA BLEE+ se incrementó ligeramente desde el 2,7% en el periodo 2005-2009 al 4,4% en el periodo 2010-2014. CONCLUSIONES: Las ITU/PNA BLEE+ se asociaron a recurrencias más frecuentes. El RVU fue el doble de frecuente en el grupo BLEE+. Piperacilina/tazobactam, meropenem y fosfomicina mostraron una excelente actividad. Los aminoglucósidos pueden ser una opción terapéutica, y en nuestra serie la gentamicina fue el antibiótico más utilizado
INTRODUCTION: Extended-spectrum beta-lactamase (ESBL) producing bacteria are infrequent pathogens of urinary tract infections in children. The objective of our study was to investigate the presence, clinically associated characteristics and risk factors for acquisition of urinary tract infection/acute pyelonephritis (UTI/APN) in hospitalised children < 2 years old caused by community-acquired ESBL. METHODS: A case-control study in a second level community hospital in Spain, in which 537 episodes of UTI/APN were investigated in a retrospective study between November 2005 and August 2014. Cases were patients with ESBL strains. For each case, four ESBL-negative controls were selected. A questionnaire with the variables of interest was completed for every patient, and the groups were compared. RESULTS: ESBL-positive strains were found in 19 (3,5%) cultures. Of these 16 (84%) were Escherichia coli. Vesicoureteral reflux (VUR) of any grade was more frequent in the ESBL group (60 vs. 29%), although without statistical significance. Relapses were more frequent in the ESBL group (42% vs. 18%) (P = .029; OR = 3.2; 95%CI: 1.09-9.5). The prevalence of UTI/APN due to ESBL-positive strains increased slightly from 2.7% in the period 2005-2009 to 4.4% in the period 2010-2014. CONCLUSIONS: ESBL UTI/APN were associated with more frequent relapses. VUR of any grade was twice more frequent in the ESBL group. Piperacillin/tazobactam, fosfomycin and meropenem showed an excellent activity. Aminoglycosides may be a therapeutic option, and in our patients gentamicin was the antibiotic most used
Assuntos
Humanos , Criança , Infecções Urinárias/microbiologia , Pielonefrite/microbiologia , Fatores de Risco , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/microbiologia , beta-Lactamases/farmacocinéticaRESUMO
INTRODUCTION: Extended-spectrum beta-lactamase (ESBL) producing bacteria are infrequent pathogens of urinary tract infections in children. The objective of our study was to investigate the presence, clinically associated characteristics and risk factors for acquisition of urinary tract infection/acute pyelonephritis (UTI/APN) in hospitalised children <2years old caused by community-acquired ESBL. METHODS: A case-control study in a second level community hospital in Spain, in which 537 episodes of UTI/APN were investigated in a retrospective study between November 2005 and August 2014. Cases were patients with ESBL strains. For each case, four ESBL-negative controls were selected. A questionnaire with the variables of interest was completed for every patient, and the groups were compared. RESULTS: ESBL-positive strains were found in 19 (3,5%) cultures. Of these 16 (84%) were Escherichia coli. Vesicoureteral reflux (VUR) of any grade was more frequent in the ESBL group (60 vs. 29%), although without statistical significance. Relapses were more frequent in the ESBL group (42% vs. 18%) (P=.029; OR=3.2; 95%CI: 1.09-9.5). The prevalence of UTI/APN due to ESBL-positive strains increased slightly from 2.7% in the period 2005-2009 to 4.4% in the period 2010-2014. CONCLUSIONS: ESBL UTI/APN were associated with more frequent relapses. VUR of any grade was twice more frequent in the ESBL group. Piperacillin/tazobactam, fosfomycin and meropenem showed an excellent activity. Aminoglycosides may be a therapeutic option, and in our patients gentamicin was the antibiotic most used.
