RISK FACTORS AND CLINICAL OUTCOMES OF FEBRILE URINARY TRACT INFECTION FROM CEFTRIAXONE-RESISTANT ENTEROBACTERACEAE IN CHILDREN
DOI:
https://doi.org/10.55374/jseamed.v10.297Keywords:
febrile urinary tract infection, ceftriaxone-resistant Enterobacteriaceae, antibiotic resistance, prevalence, Maternal risk factors, clinical outcomesAbstract
Background: Febrile urinary tract infection (FUTI) is one of the most common bacterial infections in children. It is a major cause of hospitalization and long-term renal complications, with Enterobacteriaceae being the main pathogens. Third-generation cephalosporins, particularly ceftriaxone, are widely used as first-line empirical antibiotics because of their broad-spectrum activity. Previous studies have shown that the prevalence of ceftriaxone-resistant Enterobacteriaceae is increasing both domestically and internationally. However, these studies have reported inconsistent findings regarding differences in clinical manifestations and treatment outcomes between ceftriaxone-resistant and ceftriaxonesusceptible FUTI.
Methods: We conducted a retrospective cohort study of pediatric patients diagnosed with Enterobacteriaceae-associated FUTI at Naresuan University Hospital, a tertiary hospital in the lower northern part of Thailand, from November 1, 2018, to October 31, 2024. Patients were categorized into ceftriaxone-resistant and susceptible groups. We analyzed clinical data, laboratory findings, treatment outcomes, and post-infectious imaging.
Results: Of the 52 pediatric cases, Escherichia coli was the most common pathogen (86.5%), with 77.8% ceftriaxone sensitivity. Patients with previous antibiotic use within 3 months and a history of hospitalization tended to have ceftriaxone resistance, though the difference was not significant. Moreover, patients with ceftriaxone-resistant FUTI had longer hospital stays and longer durations of intravenous antibiotic therapy; however, these differences were not statistically significant. Patients with FUTI due to ceftriaxone-resistant Enterobacteriaceae were more likely to require a change in antibiotic therapy than those with FUTI due to ceftriaxone-susceptible Enterobacteriaceae.
Conclusion: There is no significant difference in risk factors and treatment outcomes between ceftriaxone-resistant and susceptible Enterobacteriaceae FUTI. This finding indicates that third-generation cephalosporins can be used as an appropriate empirical therapy for community-onset FUTI. However, patients with FUTI should be promptly switched to targeted antimicrobials based on sensitivity results if they deteriorate clinically.
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