Extended-Spectrum β-Lactamase-Producing Bacteria in Pediatric Urinary Tract Infections

Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales have emerged as leading causes of urinary tract infections in children worldwide, undermining the efficacy of many first-line antibiotics. These enzymes, most commonly produced by Escherichia coli and Klebsiella pneumoniae, hydrolyse third-generation cephalosporins and penicillins, severely restricting empirical treatment options. In paediatric populations, risk factors for acquisition include recent antibiotic exposure, underlying urinary tract malformations, prolonged hospitalisation and indwelling devices. Molecular epidemiology has revealed the global spread of high-risk clones such as E. coli sequence type 131, often co-harbouring mobile genetic elements that carry multiple resistance determinants, including carbapenemases and plasmid-mediated quinolone-resistance genes. Clinical management is further complicated by variable presentations—from uncomplicated cystitis to febrile pyelonephritis—and by limited licensed oral agents for young children. Surveillance efforts across diverse settings demonstrate rising community-onset ESBL rates, prompting renewed interest in narrow-spectrum agents such as nitrofurantoin and fosfomycin, as well as aminoglycosides, to spare carbapenems. Integrating rapid diagnostics, antimicrobial stewardship and infection-prevention strategies is vital to curb transmission, optimise therapy and preserve the efficacy of critical antimicrobial classes.

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Extended-Spectrum β-Lactamase-Producing Bacteria in Pediatric Urinary Tract Infections publication trend

The graph below shows the total number of articles in extended-spectrum β-lactamase-producing bacteria in pediatric urinary tract infections across all publications each year (not limited to Nature Index journals).

Technical terms

Extended-spectrum β-lactamase (ESBL): An enzyme that confers resistance to penicillins and cephalosporins by hydrolysing the β-lactam ring.

Enterobacterales: An order of Gram-negative bacteria that includes common uropathogens such as Escherichia coli and Klebsiella pneumoniae.

High-risk clone: A bacterial lineage defined by sequence type that is associated with multidrug resistance and rapid global dissemination.

Plasmid: A self-replicating, mobile genetic element that mediates horizontal transfer of antibiotic resistance genes between bacteria.

Mobile genetic element: DNA segments—such as transposons or integrons—that facilitate the movement of genes within and between genomes.

References

1. Urinary Tract Infections among Febrile Infants in Qatar: Extended-Spectrum-Beta-Lactamase (ESBL)-Producing Versus Non-ESBL Organisms. Antibiotics (2024).
2. Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal. Tropical Medicine and Health (2024).
3. Genome profiling of uropathogenic E. coli from strictly defined community-acquired UTI in paediatric patients: a multicentric study. Antimicrobial Resistance & Infection Control (2023).
4. The role of the plasmid-mediated fluoroquinolone resistance genes as resistance mechanisms in pediatric infections due to Enterobacterales. Frontiers in Cellular and Infection Microbiology (2023).