Factors associated with the length of hospital stay among pediatric patients with urinary tract infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in two Peruvian hospitals
DOI:
https://doi.org/10.24265/horizmed.2025.v25n3.05Keywords:
Length of Stay , Urinary Tract Infections , Enterobacteriaceae , beta-Lactamases; PediatricsAbstract
Objective: To identify factors associated with the length of hospital stay among pediatric patients with urinary tract infections (UTIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in two Peruvian hospitals. Materials and
methods: A retrospective cohort study was conducted through a review of medical records of children with UTIs caused by ESBL-E hospitalized between 2016 and 2022 at Hospital Nacional Edgardo Rebagliati Martins (Seguro Social de Salud [EsSalud] – Peru’s Social Health Insurance) and Hospital Nacional Docente Madre Niño San Bartolomé (Ministerio de Salud [MINSA] – Ministry of Health). The primary outcome variable was the length of hospital stay, defined as the number of days between admission and discharge. Linear regression with logarithmic transformation was used to identify factors associated with longer hospital stays. Additionally, factors related to prolonged hospital stays (> 7 days) were analyzed using Poisson regression models with robust variance. Results: A total of 149 patients were included, with a median hospital stay of five days (interquartile range [IQR: 4–8 days]). Linear regression
analysis identified the factors contributing to longer hospital stays: prior exposure to intravenous antibiotic therapy (coefficient [coef]: 1.48; 95 % confidence interval [95 % CI]: 1.18–1.85; p = 0.001); resistance to the initially prescribed antibiotic (coef: 1.31; 95 % CI: 1.02–1.68; p = 0.036); low weight-for-age (coef: 1.41; 95 % CI: 1.10–1.82; p = 0.009); and delayed urine culture results (coef: 1.28; 95 % CI: 1.02–1.61; p = 0.036). In contrast, a history of genitourinary disorder was associated with a shorter hospital stay (coef: 0.80; 95 % CI: 0.64-0.99; p = 0.048). In the secondary analysis, hospitalization at EsSalud was associated with an increased risk of prolonged stay (risk ratio [RR]: 2.27; 95 % CI: 1.41–3.64). Conclusions: Several factors were associated with prolonged hospital stay among children with UTIs caused by ESBL-E. These findings may help optimize therapeutic and hospital management strategies, ultimately reducing complications and associated healthcare costs.
Downloads
References
Behzadi P, Urban E, Matuz M, Benkő R, Gajdács M. The role of Gramnegative
bacteria in urinary tract infections: current concepts and
therapeutic options. Adv Exp Med Biol. 2021;1323:35-69. Disponible en:
https://doi.org/10.1007/5584_2020_566
Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R.
Recurrent urinary tract infections in children: risk factors and association
with prophylactic antimicrobials. JAMA. 2007;298(2):179–86. Disponible
en: https://doi.org/10.1001/jama.298.2.179
Mitiku E, Amsalu A, Tadesse BT. Pediatric urinary tract infection as a
cause of outpatient clinic visits in southern Ethiopia: a cross sectional
study. Ethiop J Health Sci. 2018;28(2):187. Disponible en: https://doi.
org/10.4314/ejhs.v28i2.10
González M, Salmón A, García S, Arana E, Mintegi S, Benito J. Prevalence
of urinary tract infection in infants with high fever in the emergency
department. An Pediatr. 2019;91(6):386–93. Disponible en: https://doi.
org/10.1016/j.anpedi.2019.01.027
Hanna-Wakim RH, Ghanem ST, El Helou MW, Khafaja SA, Shaker RA, Hassan
SA, et al. Epidemiology and characteristics of urinary tract infections in
children and adolescents. Front Cell Infect Microbiol. 2015;5(45):1-8.
Disponible en: https://doi.org/10.3389/fcimb.2015.00045
Alsaywid BS, Alyami FA, Alqarni NF, Neel KF, Almaddah TO, Abdulhaq NM,
et al. Urinary tract infection in children: a narrative review of clinical
practice guidelines. Urol Ann. 2023;15(2):113–32. Disponible en: https://
doi.org/10.4103/ua.ua_147_22
Simões AC, Oliveira EA, Mak RH. Urinary tract infection in pediatrics:
an overview. J Pediatr (Rio J). 2020;96(Suppl 1):65–79. Disponible en:
https://doi.org/10.1016/j.jped.2019.10.006
Esposito S, Biasucci G, Pasini A, Predieri B, Vergine G, Crisafi A, et al.
Antibiotic resistance in paediatric febrile urinary tract infections. J
Glob Antimicrob Resist. 2022;29:499–506. Disponible en: https://doi.
org/10.1016/j.jgar.2021.11.003
Bischoff S, Walter T, Gerigk M, Ebert M, Vogelmann R. Empiric antibiotic
therapy in urinary tract infection in patients with risk factors for
antibiotic resistance in a German emergency department. BMC Infect
Dis. 2018;18(1):56. Disponible en: https://doi.org/10.1186/s12879-
-2960-9
OMS. Resistencia a los antibióticos [Internet]. OMS; 2020. Disponible en:
https://www.who.int/es/news-room/fact-sheets/detail/resistenciaa-
los-antibióticos
Colquechagua F, Sevilla C, Gonzales E. Enterobacterias productoras
de Betalactamasas de espectro extendido en muestras fecales en el
Instituto Nacional de Salud del Niño, Perú. Rev Peru Med Exp Salud
Publica. 2015;32(1):26-32. Disponible en: http://www.scielo.org.pe/
pdf/rins/v32n1/a05v32n1.pdf
Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C.
Global prevalence of antibiotic resistance in paediatric urinary tract
infections caused by Escherichia coli and association with routine use
of antibiotics in primary care: systematic review and meta-analysis.
BMJ. 2016;352:i939. Disponible en: https://doi.org/10.1136/bmj.i939
García CS, de la Gándara MP, Castillo FJ. Betalactamasas de
espectro extendido en enterobacterias distintas de Escherichia coli y
Klebsiella. Enferm Infecc Microbiol Clin. 2010;28(1):12–8. Disponible
en: https://doi.org/10.1016/S0213-005X(10)70003-3
Hassor S, Etinger V, Villacis D, Houssay M, Bukhari A, Gruber J, et
al. A case-control study evaluating risk factors and outcomes of
hospitalized children with ESBL-UTI. Clin Pediatr. 2022;61(11):759–67.
Disponible en: https://doi.org/10.1177/00099228221100064
Ramiro L, Lassaletta A, González P, Gómez JA, García E. Variables que
influyen en la duración de la hospitalización por infección del tracto
urinario. An Esp Pediatr. 2002;56(6):500–504. Disponible en: https://
doi.org/10.1016/S1695-4033(02)77858-2
McMullen JA, Mahant S, DeGroot JM, Stephens D, Parkin PC. Predictors
of long length of stay in infants hospitalized with urinary tract
infection. Hosp Pediatr. 2014;4(5):291–7. Disponible en: https://doi.
org/10.1542/hpeds.2014-0020
Desai S, Aronson PL, Shabanova V, Neuman MI, Balamuth F, Pruitt CM,
et al. Parenteral antibiotic therapy duration in young infants with
bacteremic urinary tract infections. Pediatrics. 2019;144(3):e20183844.
Disponible en: https://doi.org/10.1542/peds.2018-3844
Maldonado JP. Psicología de niños hospitalizados. Rev Av en Psicol.
;1(2):109–10. Disponible en: https://www.redalyc.org/
pdf/5605/560558783006.pdf
Spencer JD, Schwaderer A, McHugh K, Hains DS. Pediatric urinary
tract infections: an analysis of hospitalizations, charges, and costs
in the USA. Pediatr Nephrol. 2010;25(12):2469–75. Disponible en:
https://doi.org/10.1007/s00467-010-1625-8
The increase in hospitalizations for urinary tract infections and the
associated costs in the United States, 1998–2011. Open Forum Infect Dis.
;4(1):ofw281. Disponible en: https://doi.org/10.1093/ofid/ofw281
Rahme D, Chmaisse HN, Salameh P. Unraveling the length of hospital
stay for patients with urinary tract infections: contributing factors
and microbial susceptibility. Antibiotics. 2025;14(4):421. Disponible
en: https://doi.org/10.3390/antibiotics14040421
Gonzales E, Patiño L, Ore E, Martínez V, Moreno S, Cruzado NB, et
al. β-lactamasas de espectro extendido tipo CTX-M en aislamientos
clínicos de Escherichia coli y Klebsiella pneumoniae en el Instituto
Nacional de Salud del Niño-Breña, Lima, Perú. Rev Medica Hered.
;30(4):242–8. Disponible en: http://www.scielo.org.pe/scielo.
php?script=sci_arttext&pid=S1018-130X2019000400005&lng=es.
Yábar MN, Curi-Pesantes B, Torres C, Calderón-Anyosa R, Riveros
M, Ochoa TJ. Multirresistencia y factores asociados a la presencia
de betalactamasas de espectro extendido en cepas de Escherichia
coli provenientes de urocultivos. Rev Peru Med Exp Salud Publica.
;34(4):660–5. Disponible en: http://www.scielo.org.pe/scielo.
php?script=sci_arttext&pid=S1726-46342017000400012&lng=es.
Ceballos-Acevedo T, Velásquez-Restrepo PA, Jaén-Posada JS. Duración
de la estancia hospitalaria. Metodologías para su intervención. Rev
Gerenc Polít Salud. 2014;13(27):274-295. Disponible en: https://doi.
org/10.11144/Javeriana.rgyps13-27.dehm
Caldas JC, Pais-ribeiro JL, Carneiro SR. General anesthesia, surgery
and hospitalization in children and their effects upon cognitive,
academic, emotional and sociobehavioral development – a review.
Paediatr Anaesth. 2004;14(11):910-5. Disponible en: https://doi.
org/10.1111/j.1460-9592.2004.01350.x
EsSalud. Hospital Rebagliati de EsSalud alcanza máxima categoría por
su alta especialidad y capacidad resolutiva [Internet]. Lima: EsSalud;
Disponible en: http://www.essalud.gob.pe/hospital-rebagliatide-
essalud-alcanza-maxima-categoria-por-su-alta-especialidad-ycapacidad-
resolutiva/
EsSalud. Historia del Hospital Rebagliati de EsSalud en sesenta
aniversario de su inauguración [Internet]. Lima: EsSalud; 2018.
Disponible en: http://www.essalud.gob.pe/historia-del-hospitalrebagliati-
de-essalud-en-sesenta-aniversario-de-su-inauguracion/
Ministerio de Salud del Perú. Resolución Administrativa N°
-2020-DMGS-DIRIS-LC [Internet]. Lima: MINSA; 2020. Disponible en:
sieval.sanbartolome.gob.pe/transparencia/Publicacion2020/Direccion/
OFICIO%20N988-DG-DIRIS-LC,%20Categoria%20III-E.pdf
Ministerio de Salud. Análisis de la Situación de Salud HONADOMANI
SAN BARTOLOMÉ [Internet]. Lima: MINSA; 2019. Disponible en:
http://sieval.sanbartolome.gob.pe/transparencia/publicacion2019/
Direccion/RD 158 SB 2019 - ASIS 2018.pdf
Flokas ME, Detsis M, Alevizakos M, Mylonakis E. Prevalence of ESBLproducing
Enterobacteriaceae in paediatric urinary tract infections: A systematic review and meta-analysis. J Infect. 2016;73(6):547–57.
Disponible en: https://doi.org/10.1016/j.jinf.2016.07.014
Haile ZT. Power Analysis and Exploratory Research. J
Hum Lact. 2023;39(4):579-83. Disponible en: https://doi.
org/10.1177/08903344231195625
Brydges CR. Effect size guidelines, sample size calculations, and
statistical power in gerontology. Innov Aging. 2019;3(4):igz036.
Disponible en: https://doi.org/10.1093/geroni/igz036
Ministerio de Salud. Indicadores de gestión y evaluación hospitalaria,
para hospitales, institutos y DIRESA [Internet]. Lima: MINSA; 2013.
Disponible en: https://cdn.www.gob.pe/uploads/document/
file/389874/Indicadores_de_gesti%C3%B3n_y_evaluaci%C3%B3n_
hospitalaria__para_hospitales__institutos_y_DIRESA20191016-26158-
kn86l8.pdf?v=1571211553
Ministerio de Salud. Norma técnica de salud para el control del
crecimiento y desarrollo de la niña y el niño menor de cinco años.
Lima: MINSA; 2017. Disponible en: https://www.saludarequipa.gob.
pe/archivos/cred/NORMATIVA%20CRED.pdf
Ticona M, Huanco D. Curva nacional de distribución de peso al
nacer según edad gestacional en el Perú. Diagnostico. 2008; 47(2).
Disponible en: https://www.fihu.org.pe/revista/numeros/2008/abrjun/
-79.html
Albaramki JH, Abdelghani T, Dalaeen A, Khdair F, Alassaf A, Odeh R, et
al. Urinary tract infection caused by extended-spectrum β-lactamaseproducing
bacteria: risk factors and antibiotic resistance. Pediatr Int.
;61(11):1127–32. Disponible en: https://doi.org/10.1111/ped.13911
Madhi F, Jung C, Timsit S, Levy C, Biscardi S, Lorrot M, et al. Febrile
urinary-tract infection due to extended-spectrum beta-lactamaseproducing
Enterobacteriaceae in children: a French prospective
multicenter study. PLoS One. 2018;13(1):e0190910. Disponible en:
https://doi.org/10.1371/journal.pone.0190910
Jerardi KE, Auger KA, Shah SS, Hall M, Hain PD, Myers AL, et
al. Discordant antibiotic therapy and length of stay in children
hospitalized for urinary tract infection. J Hosp Med. 2012;7(8):622–7.
Disponible en: https://doi.org/10.1002/jhm.1960
González J, Maguiña C, González F. La resistencia a los antibióticos:
un problema muy serio. Acta Med Peru. 2019;36(2):145–51.
Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_
arttext&pid=S1728-59172019000200011
Instituto Nacional de Salud del Niño San Borja. Guía de Práctica
Clínica para el Diagnóstico y Tratamiento de la Infección Urinaria en
Pediatría. Lima, Perú: INSNSB; 2024. Disponible en: https://portal.
insnsb.gob.pe/docs-trans/resoluciones/archivopdf.php?pdf=2024/
GPC%20Diagn%C3%B3stico%20y%20Tratamiento%20de%20la%20
Infecci%C3%B3n%20Urinaria.pdf.
Pérez J, de la Mata S, López-Herce E, Tolín M, González F, González
MI, et al. Influencia del estado nutricional en la evolución clínica del
niño hospitalizado. An Pediatr. 2019;91(5):328–35. Disponible en:
https://doi.org/10.1016/j.anpedi.2019.01.014
Bourke C, Berkley J, Prendergast A. Immune dysfunction as a cause
and consequence of malnutrition. Trends Immunol. 2016;37(6):386-
Disponible en: https://doi.org/10.1016/j.it.2016.04.003
Li L, Georgiou A, Vecellio E, Eigenstetter A, Toouli G, Wilson R, et
al. The effect of laboratory testing on emergency department length
of stay: a multihospital longitudinal study applying a cross-classified
random-effect modeling approach. Acad Emerg Med. 2015;22(1):38–
Disponible en: https://doi.org/10.1111/acem.12565
Pérez E, Caparo IA, Bastidas G. Factores de riesgo para infección del
tracto urinario por microorganismos productores de betalactamasas
de espectro extendido en niños en Huancayo, Perú. Rev Cubana
Pediatr. 2021;93(Supl):e1355. Disponible en: https://revpediatria.
sld.cu/index.php/ped/article/view/1355
Instituto Nacional de Estadística e Informática. Población afiliada a
algún seguro de salud. Sobre la base de los resultados de los Censos
Nacionales 2017: XII de Población, VII de Vivienda y III de Comunidades
Indígenas. Lima: INEI; 2018. Disponible en: https://www.inei.gob.pe/
media/MenuRecursivo/publicaciones_digitales/Est/Lib1587/libro01.pdf
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Horizonte Médico (Lima)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Horizonte Médico (Lima) (Horiz. Med.) journal’s research outputs are published free of charge and are freely available to download under the open access model, aimed at disseminating works and experiences developed in biomedical and public health areas, both nationally and internationally, and promoting research in the different fields of human medicine. All manuscripts accepted and published in the journal are distributed free of charge under the terms of a Creative Commons license – Attribution 4.0 International (CC BY 4.0).
