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Sofia Bota1, Joana Martins2, Catarina Diamantino2, Catarina Gouveia3, Luís Varandas3,4

1- PediatriaMédica, Área da Mulher, Criança e Adolescente,Hospital Dona Estefânia, Centro Hospitalarde LisboaCentral, EPE, Lisboa
2- Equipa Fixa do Serviço de Urgência Pediátrica, Área da Mulher, Criança e Adolescente,Hospital Dona Estefânia, Centro Hospitalarde LisboaCentral, EPE, Lisboa
3- Unidade de Infecciologia, Área da Mulher, Criança e Adolescente; Hospital Dona Estefânia, Centro Hospitalarde LisboaCentral, EPE, Lisboa
4- Grupo de Coordenação Local - Programa de Prevenção e Controlo de Infecções e de ResistênciaaosAntimicrobianos, Hospital Dona Estefânia, Centro Hospitalarde Lisboa Central, EPE, Lisboa

- 35th Annual Meeting of the European Society for Paediatric Infectious Diseases (Oral Presentation)

Background: ESBL-PE community and healthcare-associated infections (HCAI) have emerged in the last years. Also, inappropriate empirical therapy and recurrent ESBL-PE infections (ESBL-PEI) are occurring more often.We aim to assess antibiotic ESBL-PE sensibilities and to identify risk factors for recurrence.
Methods: Retrospective analysis ofdata of symptomatic children (< 18 years old) with a positive ESBL-PE strain, from usually sterile sites, identified in an emergency department of a tertiary care pediatric hospital in Portugal from 2013 to 2016. Regarding urine samples, only specimens collected by catheterization, ureterostomy or clean-catch midstream, with suggestive urine analysis and more than 105 colony-forming units/mL, in symptomatic children (NICE guidelines, Hooton et al.), were included. HCAI were categorized by Friedman proposed criteria. 
Results: 42 isolates were obtained (41 urines, 1 blood sample) from 41 ESBL-PEI of 28 patients. HCAI and community ESBL-PEI were equally identified (49% and 51%). Nine patients had more than one ESBL-PEI (total of 22 episodes). 60% patients had an associated pathology. 58% had a previous ESBL-PE isolate (colonization or infection) in the last 12 months. Escherichia coli was found in 67%. 85% of all isolates were susceptible to nitrofurantoin. Empiric therapy was inappropriate in 73%. The recurrent ESBL-PEI group had more than one antibiotic cycle in the preceding 12 months (P 0.017). Potential risk factors for recurrent ESBL-PEI were identified as clean intermittent catheterization (CIC), hospitalization in the last 3 months, use of antibiotics in the last 3 months and in the last 30 days (P<0.05). On logistic regression analysis, CIC was identified as an independent risk factor (P 0.029).
Conclusions: CIC, hospitalization and antibiotherapy in the last 3 months should be considered risk factors for recurrent ESBL-PEI. Empiric treatment protocols should be developed to avoid recurrence.

Palavras Chave: Extended-Spectrum B-Lactamase Producing Enterobacteriacae, ESBL, Infection