The Gut-Urinary Axis in Pediatrics: Fecal Carriage of ESBL-Producing Escherichia coli and Community-Acquired Urinary Tract Infections

Abstract

Objectives Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) is a major driver of multidrug resistance in pediatric urinary tract infections (UTIs). This study investigated fecal ESBL carriage prevalence in children with UTIs and their parents to assess associations with infection phenotypes. Methods One-hundred and thirty-three children with E. coli UTIs were categorized into ESBL-positive and non-ESBL groups. Fecal samples were obtained from all children and 190 consenting parents. ESBL production was identified using standard phenotypic methods. Results ESBL-producing E. coli was detected in 47 (35.4%) urine cultures. Fecal ESBL carriage was significantly more frequent in children with ESBL-positive UTIs (n = 25, 53.2%) compared to non-ESBL group (n = 20, 23.3%) (P < 0.001). Although higher parental ESBL carriage rates were observed in children with ESBL-positive UTIs (11.7% mothers, 20.0% fathers), differences were not statistically significant. Conclusions Fecal carriage of ESBL-producing E. coli is strongly associated with ESBL-positive UTIs, supporting the role of intestinal colonization in infection pathogenesis.