Urinary Tract Infection Caused by the Extended-Spectrum β-lactamase (ESBL)-Producing Enterobacteriaceae in Hospitalized Pediatric Patients before and after Ceftriaxone Restriction Policy in a Tertiary Referral Hospital

Objectives: The third-generation cephalosporins have been very widely used in Indonesia, raising concerns about the increase of infections caused by multidrug resistance organisms, in particular the extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-pE). Dr. Kariadi Hospital (DKH), Semarang, Indonesia, implemented the policy of ceftriaxone restriction since November 2018. This study aimed to describe the prevalence of urinary tract infections (UTI) caused by ESBL-pE during 2018 -2019, the origin of the ESBL-pE strains, the risk factors of developing ESBL-pE UTI, and the antibiotic options for ESBL-pE UTI paediatric patients. Methods. A retrospective cross-sectional study was performed by collecting data from microbiology laboratory and medical records of paediatric patients hospitalized with UTI in DKH, from January 2018 to December 2019. Statistical analysis was performed using Chi-square or Fisher-exact test. Results: UTI was microbiologically confirmed in 318. Enterobacteriacea caused UTI in 86 (59%) patients, of these 56.4% (in 2018) dan 62.9 (in 2019) were ESBL-pE strains.  E. coli and K. pneumoniae were the most common etiology of UTI. ESBL-pE was isolated from 42% UTI patients from the community and from 76% UTI patients referred from other hospitals (p < 0.01). Most strains were susceptible to amikacin, meropenem, and fosfomycin with a tendency of lower susceptibility in 2019 than in 2018 (p> 0.05) Conclusion: The UTI incidence caused by ESBL-pE in DKH was high. Patients referred from other hospitals were important source of ESBL-pE UTI, underlining the urgency to perform surveillance and to implement the infection control and prevention measures in addition to the antibiotic stewardship program.