Epidemiological profile and risk factors of community-acquired caused by enterobacteria strains producing ESBL urinary tract infections in Tunisian children
DOI:
https://doi.org/10.62438/tunismed.v104i01.6232Keywords:
Urinary tract infections , Child, antibiotic resistance , risk factorAbstract
Introduction:
The rise in community-acquired urinary tract infections (UTI) caused by enterobacteria strains producing extended spectrum beta-lactamase (ESBL)in children has complicated treatment strategies.
Objective:
This study aimed to evaluate risk factors associated with ESBL-producing UTIs in pediatric patients and analyze the antibiotic resistance patterns of the causative pathogens.
Methods:
A six-year cross-sectional study (January 2019–December 2024) was conducted at Sahloul University Hospital’s pediatric department, including children under 15 years hospitalized with community-acquired UTIs.
Results:
A total of 383 UTI were included with 20.4% of UTI caused by ESBL producing strains. Females represented 62.66% (sex ratio=0.59). The median patient age was 11 months [3-66].
Escherichia coli and Klebsiella pneumoniae were the most common isolates (80.4% and 12.27%). Common risk factors included prior antibiotic use (41%), hospitalization in the past year (30.81%), recurrent UTIs (20.89%), and the presence of malformative uropathy (8.62%).Multivariate analysis confirmed only prior hospitalization (≤12 months) as an independent factor with ESBL strains(p = 0.005).
Conclusion:
The increasing prevalence of ESBL-related UTIs in children calls for stricter antibiotic stewardship and ongoing surveillance of resistance trends in this population.
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References
Launay E, Bingen E, Cohen R. Stratégies thérapeutiques dans les infections urinaires du nourrisson et de l’enfant. Arch Pediatr. 2012;19(2):109-116. doi:10.1016/j.arcped.2011.12.019.
Bouassida A, Asli MS, Barguellil F. Epidémiologie des infections urinaires communautaires chez l’enfant et résistance bactérienne aux antibiotiques. Rev Tunis Biol Clin. 2021;28:35-41.doi.org/10.71699/revtunbiolclin.v28i2.132
Duong HP, Mong Hiep TT, Hoang DT, Janssen F, et al. Difficultés de prise en charge des infections urinaires fébriles chez l’enfant vietnamien. Arch Pediatr. 2015;22(8):848-852. doi:10.1016/j.arcped.2015.05.007.
Dorbani L, Ghazioui A, Hamdi W. Revue de littérature sur les infections urinaires. Faculté des Sciences de la Nature et de la Vie, Sciences de la Terre et de l’Univers Guelma. 2021.
Zahir H, Draiss G, Rada N, Abourrahouat A, et al. Écologie microbienne et sensibilité aux antibiotiques des bactéries isolées d’infections urinaires chez l’enfant au Maroc. RevFrancoph Lab. 2019;(519):65-70.
Madiagne D, Niang AA. Prevalence and antibiotic resistance profile of extended spectrum beta lactamase producing uropathogenic Enterobacteriaceae isolated at the Bacteriology Virology Laboratory of CHNU de Fann, Dakar. Afr J Biol Med Res. 2024;7:39 46. doi:10.52589/AJBMR Z1G94ONP
Sonnet M. Les entérobactéries face aux céphalosporines de 3ème génération et carbapénèmes : évolution, actualité, problématique. Faculté de Médecine Vétérinaire Liège université.2020.
Eddair MY. La résistance aux bêta-lactamines par production de bêta-lactamase à spectre élargi chez les entérobactéries : caractérisation phénotypique et génotypique [thèse]. Rabat (Maroc) : Faculté de Médecine et de Pharmacie ; 2021. Thèse N°071
Flokas ME, Karanika S, Alevizakos M, Mylonakis E. Prevalence of ESBL-Producing Enterobacteriaceae in Pediatric Bloodstream Infections: A Systematic Review and Meta-Analysis. PLoS One. 2017;12(1):e0171216. doi:10.1371/journal.pone.0171216.
Marzouk M, Ferjani A, Haj Ali M, Boukadida J. Profil et sensibilité aux antibiotiques de 1879 bactéries urinaires pathogènes isolées chez l’enfant (2012–2013). Arch Pediatr. 2015;22(5):505-509. doi:10.1016/j.arcped.2015.02.010.
Mefteh K. L’antibio-résistance en Tunisie – données 2022 : Escherichia coli. Tunis : LART ; 2022 [consulté le 29 juin 2025]. Disponible sur : https://www.infectiologie.org.tn/pdf_ppt_docs/resistance/1544644887
Boutiba I. L’antibio-résistance en Tunisie – données 2022 : Klebsiella pneumoniae. Tunis : LART ; 2022 [consulté le 29 juin 2025]. Disponible sur : https://www.infectiologie.org.tn/pdf_ppt_docs/resistance/1544644887
Boutiba I, Ben Boubaker I, Slim A, Saidani M, et al. L’antibio-résistance en Tunisie – données 2011 :Escherichia coli. Tunis : LART ; 2011 [consulté le 29 juin 2025]. Disponible sur : https://www.infectiologie.org.tn/pdf_ppt_docs/resistance/1544644887
Marzouk M, Ferjani A, Haj Ali M, Boukadida J. Profil et sensibilité aux antibiotiques de 1879 bactéries urinaires pathogènes isolées chez l’enfant (2012–2013). Arch Pediatr. 2015;22(5):505-509. DOI: 10.1016/j.arcped.2015.02.010.
Mokni S, Kadri Y, Ben Salem N, Rhim H, Mhalla S, Toumi A, et al. Profil microbiologique des infections urinaires chez l’enfant. Médecine Mal Infect Form 2022 ;1 : S108–9. Doi : 10.1016/j.mmifmc.2022.03.236
Jorda A, Gabler C, Blaschke A, Wölfl-Duchek M, et al. Community-acquired and hospital-acquired bacterial co-infections in patients hospitalized with Covid-19 or influenza: a retrospective cohort study. Infection. 2024;52:105-115. doi:10.1007/s15010-023-02059-y.
Cosentino, Federicaa,b; Viale, Pierluigia,b; Giannella, Maddalenaa,b. MDR/XDR/PDR or DTR? Which definition best fits the resistance profile of Pseudomonas aeruginosa?.Current Opinion in InfectiousDiseases 36(6):p 564-571, December 2023. | DOI: 10.1097/QCO.0000000000000966
Garnier M. Bactéries multirésistantes : impact sur le pronostic en réanimation. Anesth Réanimation 2020 ;6 :219–25. doi.org/10.1016/j.anrea.2020.01.008
World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. JAMA. 2025 Jan 7;333(1):71-74. doi: 10.1001/jama.2024.21972.
Livermore, D. M., & Woodford, N. (2006). The β-lactamase threat in Enterobacteriaceae, Pseudomonas and Acinetobacter. Trends in Microbiology, 14(9), 413-420.DOI: 10.1016/j.tim.2006.07.008
Yashraj A. FrontiersTeam et coll. High prevalence of ESBL-producing E. coli in community-acquired UTIs in China: a multicenter study. Front Microbiol.2021;12:663033. doi: 10.3389/fmicb.2021.663033.
Smaoui S, Abdelhedi K, Marouane C, Kammoun S, Messadi-Akrout F. Résistance aux antibiotiques des entérobactéries responsables d’infections urinaires communautaires à Sfax (Tunisie). Med Mal Infect. 2015;45(8):335-337. doi:10.1016/j.medmal.2015.05.003.
Fabre R, Mérens A, Lefebvre F, Epifanoff G, et al. Sensibilité aux antibiotiques des Escherichia coli isolés d’infections urinaires communautaires. Med Mal Infect. 2010;40(10):555-559. doi:10.1016/j.medmal.2010.03.011.
Rodrigues L, Silva M, Pereira A, et al. Urinary tract infections in older adults: associated factors for extended-spectrum beta-lactamase production. Front Microbiol.2024;15:1384392. doi:10.3389/fmicb.2024.1384392
Türkan Tüzün, Selda Sayın Kutlu, Murat Kutlu, Ilknur Kaleli. Risk factors for community onset urinary tract infections caused by extended spectrum β lactamase producing Escherichia coli. Turk J Med Sci. 2019;49(6):1206–1211. doi:10.3906/sag-1902-24
Soyaltın E, Erfidan G, Kavruk M, ArslansoyuÇamlar S, Yılmaz N, Alaygut D, et al. Predictors of febrile urinary tract infection caused by extended spectrum beta lactamase producing bacteria. Turk J Pediatr. 2022;64(2):265–73. doi:10.24953/turkjped.2020.2371.
Collingwood JD, Wang L, Aban IB, Yarbrough AH, Boppana SB, Dangle PP. "Risk factors for community-acquired pediatric urinary tract infection with extended-spectrum-β-lactamase-producing Escherichia coli: A case-control study." Journal of Pediatric Urology. 2023;19(1):129.e1-129.e7. doi:10.1016/j.jpurol.2022.10.020
Lu J, Wang L, Wei Y, Wu S, Wei G. Trends and risk factors of extended-spectrum beta lactamase urinary tract infection in Chinese children: a nomogram is built and urologist should act in time. TranslPediatr. 2022 Jun;11(6):859-868. doi: 10.21037/tp-21-523.
Hassor S, Etinger V, Villacis DS, Houssay M, Bukhari A, Gruber J et al. A Case-Control Study Evaluating Risk Factors and Outcomes of Hospitalized Children With ESBL-UTI. Clin Pediatr (Phila). 2022 Nov;61(11):759-767. doi: 10.1177/00099228221100064.
Topaloglu R, Er I, Dogan BG, Bilginer Y, et al. Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children. Pediatr Nephrol. 2010;25(5):919-925. doi:10.1007/s00467-009-1431-3.
Autore G, Bernardi L, Ghidini F, La Scola C, et al. Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group. Antibiotics. 2023;12(6):1040. doi:10.3390/antibiotics12061040.
Birgy A, Madhi F, Jung C, Levy Birgy C, et al. Diversity and trends in population structure of ESBL-producing Enterobacteriaceae in febrile urinary tract infections in children in France from 2014 to 2017. J AntimicrobChemother. 2020;75(1):96-105. doi:10.1093/jac/dkz423.
Yun KW, Kim HY, Park HK, Kim W, Lim IS. Virulence factors of uropathogenic Escherichia coli of urinary tract infections and asymptomatic bacteriuria in children. J MicrobiolImmunol Infect. 2014;47(6):455-461. doi:10.1016/j.jmii.2013.07.010.
Jamali L, Haouzane F, Bouchakour M, Oufrid S, et al. Prevalence of plasmid mediated quinolone resistance genes among enterobacteria isolates in Moroccan community. Int J Innov SciRes. 2014;11(2):387-399.
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