Article in Japanese

A pediatric case of recurrent urinary tract infection caused by extended-spectrum β-lactamase producing Escherichia coli

Tetsuo SHODA, Atsushi ISOZAKI

A previously well-growing 3-month-old girl had a sudden onset of high fever and visited our emergency department. We diagnosed her condition as urinary tract infection (UTI) by pyuria. The initial administration of antibiotics was continued for several days and then changed to Faropenem (FRPM) based on antimicrobial susceptibility, because the Extended-spectrum β-lactamase (ESBL) producing Escherichia coli (CTX-M-1) was singly isolated from her urine culture.
The voiding cystourethrogram (VCUG) revealed grade III right vesicoureteral reflux (VUR), so we began prophylactic Trimethoprim-sulfamethoxazole (TMP/SMX) administration. After the first episode of UTI, she repeated UTI twice in a short period despite the prophylaxis. We had no choice but to perform surgery on the VUR when she was only 11 months of age.
Whereas ESBL-producing organisms have been recognized as a cause of nosocomial infection, reports of community acquired infection have been increasing, including pediatric cases. Infants with UTI often complicate with VUR, increasing the prevalence of multi drug resistant bacteria including ESBL-producing organisms. This may increase the necessity of surgical procedure in infancy. Physicians should pay attention to the prevalence of these resistant organisms and take appropriate measures promptly.

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Department of Pediatrics, Yokohama City Minato Red Cross Hospital

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Received	February 26, 2010
Accepted	March 23, 2010

22 (3)：205─209,2010