BACKGROUND AND OBJECTIVES Limited data are available on the contemporary epidemiology, clinical management, and health care utilization for pediatric urinary tract infection (UTI) due to third-generation cephalosporin-resistant Enterobacterales (G3CR) in the United States. The objective is to describe the epidemiology, antimicrobial treatment and response, and health care utilization associated with G3CR UTI. METHODS Multisite, matched cohort-control study including children with G3CR UTI versus non-G3CR UTI. UTI was defined as per American Academy of Pediatrics guidelines, and G3CR as resistance to ceftriaxone, cefotaxime, or ceftazidime. We collected data from the acute phase of illness to 6 months thereafter. RESULTS Among 107 children with G3CR UTI and 206 non-G3CR UTI with documented assessment of response, the proportion with significant improvement on initial therapy was similar (52% vs 57%; odds ratio [OR], 0.81; 95% confidence interval [CI], 0.44-1.50). Patients with G3CR were more frequently hospitalized at presentation (38% vs 17%; OR, 3.03; 95% CI, 1.77-5.19). In the follow-up period, more patients with G3CR had urine cultures (75% vs 53%; OR, 2.61; 95% CI, 1.33-5.24), antimicrobial treatment of any indication (53% vs 29%; OR, 2.82; 95% CI, 1.47-5.39), and subspecialty consultation (23% vs 6%; OR, 4.52; 95% CI, 2.10-10.09). In multivariate analysis, previous systemic antimicrobial therapy remained a significant risk factor for G3CR UTI (adjusted OR, 1.91; 95% CI, 1.06-3.44). CONCLUSIONS We did not observe a significant difference in response to therapy between G3CR and susceptible UTI, but subsequent health care utilization was significantly increased.

中文翻译：

---

第三代头孢菌素耐药性尿路感染的治疗和流行病学。

背景和目标 在美国，关于由第三代头孢菌素耐药肠杆菌 (G3CR) 引起的小儿尿路感染 (UTI) 的当代流行病学、临床管理和医疗保健利用的数据有限。目的是描述与 G3CR UTI 相关的流行病学、抗菌治疗和反应以及医疗保健利用。方法 多中心、匹配的队列对照研究，包括 G3CR UTI 与非 G3CR UTI 儿童。UTI 根据美国儿科学会指南定义，G3CR 定义为对头孢曲松、头孢噻肟或头孢他啶的耐药性。我们收集了从疾病急性期到之后 6 个月的数据。结果 在 107 名 G3CR UTI 儿童和 206 名非 G3CR UTI 儿童中，有记录的反应评估，初始治疗有显着改善的比例相似（52% 对 57%；比值比 [OR]，0.81；95% 置信区间 [CI]，0.44-1.50）。G3CR 患者在就诊时住院的频率更高（38% 对 17%；OR，3.03；95% CI，1.77-5.19）。在随访期间，更多的 G3CR 患者进行了尿培养（75% vs 53%；OR，2.61；95% CI，1.33-5.24）、任何适应症的抗菌治疗（53% vs 29%；OR，2.82； 95% CI，1.47-5.39）和专科咨询（23% 对 6%；OR，4.52；95% CI，2.10-10.09）。在多变量分析中，先前的全身抗菌治疗仍然是 G3CR UTI 的重要危险因素（调整后的 OR，1.91；95% CI，1.06-3.44）。结论 我们没有观察到 G3CR 和易感 UTI 之间对治疗的反应有显着差异，