Clinical impacts and management of urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: a narrative review

The incidence of pediatric urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) has increased worldwide; however, optimal empirical treatment strategies remain controversial. This review addresses the prevalence, virulence factors, clinical impacts, and antibiotic management of UTIs caused by ESBL-PE in children. The prevalence of ESBL-PE among pediatric UTI isolates exceeds 20% in many regions, including Korea. No significant differences exist in the clinical manifestations between ESBL(+) UTIs and other UTIs. Despite in vitro resistance, third-generation cephalosporins frequently achieve therapeutic success because of their high urinary drug concentrations. Based on the patient’s condition and risk factors, an initial empirical antibiotic should be selected, and early de-escalation and carbapenem-sparing strategies are essential to balance treatment efficacy and resistance prevention. Therefore, Korean guidelines for the treatment of pediatric UTIs are required.