Risk factors for cefazolin-resistant febrile urinary tract infection in children.
BACKGROUND
Febrile urinary tract infection (fUTI) is a common bacterial infection among children. This study investigated the risk factors for febrile urinary tract infection (fUTI) caused by cefazolin-resistant bacteria in children.


METHODS
The medical records of patients with fUTI hospitalized between April 2014 and March 2020 were retrospectively analyzed. The patients were divided into two groups on the basis of the cefazolin susceptibility of the infection-causing bacteria: cefazolin-resistant and cefazolin-susceptible groups.


RESULTS
The records of 80 patients were evaluated. The median age was 5.0 (0.5-119.4) months. Cefazolin-susceptible bacteria were detected in 60 patients (75.0%). Significant differences were noted between the cefazolin-resistant and cefazolin-susceptible groups regarding UTI-related antimicrobial prophylaxis and recurrence of UTI within 3 months (p=0.0318 and p=0.00876, respectively). However, no significant differences were observed between these two groups regarding renal anomalies, UTI history. Logistic regression analysis revealed that the recurrence of UTI within 3 months was an independent significant risk factor for cefazolin-resistant fUTI (OR 3.81, 95% CI: 1.07-13.5, p=0.0388). Six patients who were empirically treated with antibiotics ineffective against the infection-causing bacteria recovered from fever before these antibiotics were switched to those effective against the infection-causing bacteria.


CONCLUSIONS
In children, a recurrence of UTI within 3 months is a risk factor for fUTI caused by cefazolin-resistant bacteria. Recognizing these risk factors before initiating fUTI treatment may support the treatment with narrower-spectrum antibiotics such as the first-generation cephalosporins (e.g., cefazolin) in children.
['Nakanishi|Keita|K|', 'Okutani|Takahiro|T|https://orcid.org/0000-0003-3435-8687', 'Kotani|Shinpei|S|', 'Kamoi|Yoshiaki|Y|', 'Kim|Sooyun|S|', 'Yamane|Masayuki|M|']
risk factors urinary tract infections cefazolin drug resistance