2417. Risk factors, response to empiric therapy, and healthcare utilization among children with UTI due to extended spectrum beta-lactamase-producing Enterobacteriaceae
Session: Poster Abstract Session: Treatment of AMR Infections
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • DR-pUTI Poster - IDWeek 10_2018 FINAL.pdf (262.0 kB)
  • Background:

    There are few data on risk factors, chosen therapy and healthcare utilization among US children with extended spectrum beta lactamase-positive urinary tract infection (ESBL UTI). We performed a multicenter case-control study on childhood ESBL UTI from Nov 2014-Feb 2017; herein we present preliminary data from a single Los Angeles County hospital.

    Methods:

    We defined UTI per 2011 AAP guidelines and ESBL per CLSI specifications. ESBL (-) UTI controls were matched by sex and age. Descriptive and matched univariate analyses on medical record data (up to 6 months after index culture) were performed.

    Results:

    Among 893 urinary Enterobacteriaceae isolates, 28 were ESBL(+),of which 23 were included: 13 girls, 0-5yo; 4 girls, ≥6yo; and 6 boys, 0-5yo. Prior hospitalization (55 vs 78% for cases vs controls, respectively), prior receipt of systemic antibiotics (55 vs 38%), index hospitalization (39 vs 20%), mean length of stay (3.9 vs 3.6d), and medical comorbidity (44 vs 56%) did not differ significantly between groups. As well, several biosocial risk factors were similar in both groups, including: race, ethnicity, non-English-speaker, access to public benefits, international travel, non-US-birth, domestic violence/child abuse/neglect, and housing insecurity. Of cases and controls receiving any therapy, 16% and 96%, respectively, got empiric antibiotics to which the isolate was susceptible (p=0.001). After culture results were available, only 39% of cases and 96% of controls received effective agents (p=0.00002). Forty-two percent of cases had clinical improvement (within a mean of 2-3d), vs 43% of controls. Total treatment duration did not differ, and no deaths were recorded. In the 6 months after index UTI, groups did not differ in number of clinical encounters, proportion with documented follow-up, repeat urine tests, receipt of additional therapy, or prophylactic antibiotics. The proportions undergoing any GU-specific imaging were similar (62 vs 47%), but this imaging included modalities with ionizing radiation in 4 cases vs. none of the controls (p<0.05).

    Conclusion:

    Our data suggest that clinical improvement occurs with initial (and potentially ineffective) empiric regimens, regardless of ESBL phenotype. The finding of more ionizing radiation exposure warrants additional study.

    Shom Dasgupta-Tsinikas, MD, Division of Pediatric Infectious Diseases (Department of Pediatrics), Harbor-UCLA Medical Center, Torrance, CA, Kenneth Zangwill, MD, Harbor-UCLA Med. Center & LABioMed, Torrance, CA, Tam Van, PhD, Harbor-UCLA Med. Center, Torrance, CA, Scott Friedlander, MPH, LABioMed, Torrance, CA and Sylvia H. Yeh, MD, Division of Pediatric Infectious Diseases, David Geffen School of Medicine at UCLA/Harbor-UCLA Medical Center Department of Pediatrics, Torrance, CA

    Disclosures:

    S. Dasgupta-Tsinikas, None

    K. Zangwill, None

    T. Van, None

    S. Friedlander, None

    S. H. Yeh, None

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