Frequency of Extended Spectrum Beta-Lactamase Positive Enterobacteriaceae in Children with Urinary Tract Infection and The Role of Fecal Carriage on The Risk of Urinary Tract Infection

Objective: The most common cause of fever in children, following upper respiratory tract infections, is urinary tract infections (UTIs). Inadequately treated UTIs can result in kidney damage. The presence of extendedspectrum beta-lactamase (ESBL)-positive agents significantly affects treatment response and mortality rates. Fecal colonization contributes to the etiology of UTIs. However, the effects of ESBL-positive enteric bacterial carriage on the risk of UTI and its clinical consequences in children remain largely unknown. This study aims to determine the frequency of ESBL-positive Enterobacteriaceae in children with UTIs and to assess the role of fecal carriage in these infections. Material and Methods: Among the patients admitted to the Department of Pediatrics at Selçuk University Faculty of Medicine between 2019 and 2020, 132 children were included in the study upon filling out the volunteer consent form. In this prospective study, various data were recorded in a standard form, including the patients’ age, sex, admission complaints, diagnosis, results of urine and blood tests, use of prophylaxis, urinary ultrasonography and dimercaptosuccinic acid scintigraphy results, history of hospitalization and antibiotic use in the past three months, yogurt consumption, and probiotic use. Additionally, urine and stool cultures were collected from all patients. Results: Mean age of the 132 children included in the study was 4.90 ± 4.70 years, and 55 (41.7%) of them were boys. Fifty-three children with UTIs formed the patient group, while 80 children without UTIs comprised the control group. There was no significant difference in age and sex distribution between the two groups. Escherichia coli was identified in 66% of urine cultures, and Klebsiella species were found in 26.4%. Extended-spectrum beta-lactamase (ESBL)-positive agents were detected in 28.3% of the positive urine cultures. In patients with positive urine cultures, higher blood leukocyte levels, increased rates of hospitalization, and antibiotic use in the past three months were observed. Additionally, these patients had lower yogurt consumption, and urinary system anomalies were detected on ultrasound in 39.1% of them. The rate of ESBL-positive growth in stool cultures was 30.2% in the patient group and 24% in the control group (p= 0.254). No statistically significant relationship was found between ESBL growth status in the stool, the presence or absence of growth in the urine culture, and hospitalization status in the last three months (p= 0.097 and p= 0.542, respectively). ESBL-positive agent was produced in the stool of 30.2% of children with UTI. In patients with positive urine cultures, the rate of ESBL positivity in stool was statistically significantly higher than the rate of ESBL negativity (p= 0.003). However, no statistically significant relationship was found between ESBL-positive growth in urine culture and ESBL-positive growth in stool culture (p= 0.546). Conclusion: ESBL-positive growth in the stool may pose a risk for UTIs in children.