Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection
D Prais1, R Straussberg, Y Avitzur
1Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva. daprais@hotmail.com
Insights
Antibiotic resistance in pediatric urinary tract infections (UTIs) has increased over a decade. Susceptibility to common oral antibiotics like cephalexin has decreased, impacting empirical treatment choices for UTIs.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance
- Clinical microbiology
Background:
- Urinary tract infections (UTIs) are common in children.
- Oral antibiotics like sulphonamides and cephalosporins are frequently used for UTIs.
- Emerging antimicrobial resistance poses a challenge to effective UTI treatment.
Purpose of the Study:
- To evaluate changes in the susceptibility of urinary pathogens to oral antibiotics over a ten-year period in children with community-acquired UTIs.
- To assess the impact of evolving resistance patterns on antibiotic treatment strategies for pediatric UTIs.
Main Methods:
- A comparative study involving two groups of children with their first community-acquired UTI: one group from 1991 (n=142) and another from 1999 (n=124).
- Urine specimens were collected using appropriate methods (suprapubic aspiration, catheterization, or midstream) from symptomatic children.
- Antimicrobial susceptibility testing was performed on isolated pathogens, and results were compared between the two study groups.
Main Results:
- Pathogen prevalence remained similar, with Escherichia coli being the most common (86% in 1991, 82% in 1999).
- A general decrease in bacterial susceptibility to several oral antibiotics was observed between 1991 and 1999.
- Significant decreases in susceptibility were noted for cephalexin (82% to 63%) and ampicillin (35% to 30%). Co-trimoxazole showed increased susceptibility (60% to 69%).
- In 1999, resistance rates were high for ampicillin (70%) and cephalexin (37%), while lower for amoxicillin-clavulanate (24%) and nitrofurantoin (8%).
Conclusions:
- A slight but generalized decline in oral antibiotic susceptibility among urinary pathogens in children was observed over the decade.
- Empirical treatment with co-trimoxazole or cephalexin is insufficient for approximately one-third of pediatric UTI cases due to resistance.
- Amoxicillin-clavulanate and cefuroxime-axetil demonstrate better efficacy, with lower resistance rates (24% and 5% respectively in 1999).
Background:
The most common oral antibiotics used in the treatment of urinary tract infection (UTI) are sulphonamides and cephalosporins, but emerging resistance is not unusual.
Aims:
To assess the change in susceptibility of urinary pathogens to oral antibiotics during the past decade in children with community acquired UTI.
Methods:
The study sample included two groups of children with a first community acquired UTI: 142 children enrolled in 1991 and 124 enrolled in 1999. UTI was diagnosed by properly collected urine specimen (suprapubic aspiration, transurethral catheterisation, or midstream specimen in circumcised males) in symptomatic patients. Antimicrobial susceptibility of the isolates was compared between the two groups.
Results:
The pathogens recovered in the two groups were similar: in 1991--E coli 86%, Klebsiella 6%, others 8%; in 1999--E coli 82%, Klebsiella 13%, and others 5%. A slight but generalised decrease in bacterial susceptibility to common antibiotics in the two groups was shown: ampicillin 35% versus 30%; cephalexin 82% versus 63% (p < 0.001); nitrofurantoin 93% versus 92%. The only exception was co-trimoxazole, 60% versus 69%. Overall resistance to antibiotics in 1999 was as follows: ampicillin 70%, cephalexin 37%, co-trimoxazole 31%, amoxicillin-clavulanate 24%, nitrofurantoin 8%, cefuroxime-axetil 5%, nalidixic acid 3%.
Conclusions:
This study shows a slight but generalised decrease in bacterial susceptibility to common oral antibiotics in the past decade in our population. Empirical initial treatment with co-trimoxazole or cephalexin is inadequate in approximately one third of UTI cases. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate (24% resistance); 95% of organisms are susceptible to cefuroxime-axetil.
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