ESBL-producing, gentamicin-resistant UTI more common during first week of life

A recent study provides further evidence to support the current recommendations for empirical intravenous treatment with gentamicin and ampicillin for febrile infants younger than 2 months with suspected urinary tract infection (UTI).

“However, modification of the treatment protocol should be considered for infants younger than 7 days, who had higher rates of extended spectrum beta-lactamase (ESBL)-producing and gentamicin-resistant Gram-negative UTI,” the authors said.

A total of 1,142 infants were included in this study, of whom 65 (5.7 percent) had gentamicin-resistant UTI and 64 (5.6 percent) had ESBL-producing Gram-negative UTI. Additionally, 42 percent of ESBL-associated UTI were resistant to gentamicin.

Higher rates of ESBL were noted during the first week of life (14.8 percent vs 4.1‒7.7 percent; p=0.009). Likewise, this age group had higher rates of gentamicin resistance (11.2 percent). Infants with ESBL-associated UTI had higher rates of admission to paediatric intensive care units (ICU; 9.8 percent vs 3.5 percent; p=0.015).

Notably, gestational bacteriuria, previous neonatal ICU admission, and gender showed no significant association with either gentamicin or ESBL-producing resistance.

This multicentre, retrospective, cross-section study examined infants younger than 2 months with UTI who visited Clalit Health Services paediatric emergency departments in Tel Aviv, Israel, between 1 January 2016 and 31 December 2021.

The prevalence of ESBL-associated and gentamicin-resistant UTI was the primary outcome. Factors associated with such resistant bacteria served as a secondary outcome measure.

“Reducing the risk of renal scarring in infants with UTI necessitates timely and effective administration of antimicrobial treatment,” the authors said. “The Israeli Medical Association recommends the empirical use of gentamicin and ampicillin for febrile infants younger than 2 months with suspected UTI.”