Febrile urinary tract infection (FUTI) is one of the most common bacterial infections in children. Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) involved in these infections are increasing worldwide. The aim of this study is to establish risk factors (RFs) for developing community-acquired FUTI due to ESBLE in children. The secondary objectives are to analyze therapeutic options used in probabilistic and definitive treatments and their efficacy.

In this single-center, retrospective, case-control study conducted at Toulouse Children’s Hospital between 1st January 2016 and 31 December 2020, we identified all children hospitalized for FUTI. ESBLE-mediated FUTI was the case group. The control group comprising non-ESBLE-mediated FUTIs was randomly selected and matched according to age and year of diagnosis with a ratio of 1 case for 3 controls.

264 children were enrolled, 66 in the ESBLE-mediated FUTIs group and 198 in the non-ESBLE-mediated FUTIs group. RFs found to be significant were antibiotic therapy in the previous 3 months ( p 0.0018 ); hospitalization in the previous 3 months ( p < 0.001 ); hospitalization in an intensive care unit in the previous 3 months ( p < 0.016 ); recurrence of FUTI whatever the delay ( p 0.042 ); travel to a highly endemic area in the previous 3 months ( p 0.003); a history of infection due to resistant bacteria ( p < 0.001 ); CAKUT ( p 0.018 ); antibiotic prophylaxis ( p 0.045 ); the number of days presenting fever prior to diagnosis ( p 0.03 ). In multivariate analysis, the independent RFs were: hospitalization in the previous 3 months (ORa 3.6 [1.9–6.9]), history of infection due to resistant bacteria (ORa 20.9 [5–311]) and the number of days presenting fever prior to diagnosis (ORa 1.3 [1.1–1.6]).

Identifying risk factors for developing community-acquired FUTI due to ESBLE may allow for better management of patients.