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Cephalosporin resistant urinary tract infections in young children
S S Mehr1, C V E Powell, N Curtis
1Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Australia.
Insights
Antibiotic resistance in pediatric urinary tract infections (UTIs) is high in Australia. Ampicillin/amoxycillin and cephalothin/cephalexin show significant resistance, questioning their use for empiric UTI treatment in children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Pharmacy
Background:
- Urinary tract infections (UTIs) are common in children.
- Antibiotic resistance patterns are crucial for effective treatment, especially in pediatric populations.
- Understanding local resistance trends informs empirical treatment guidelines.
Purpose of the Study:
- To determine the antibiotic resistance patterns of common UTI-causing bacteria in Australian children under six years old.
- To assess the suitability of commonly prescribed antibiotics for empiric UTI treatment in this demographic.
Main Methods:
- A 12-month prospective study at Sunshine Hospital, Victoria, involving children under six with suspected UTIs.
- Bacterial isolates from 100 culture-proven UTIs were analyzed for antibiotic susceptibility.
- Data on patient demographics, clinical features, and imaging findings were collected.
Main Results:
- Escherichia coli was the predominant pathogen (90%).
- High in vitro resistance rates were observed: ampicillin/amoxycillin (52%), trimethoprim (14%), and cephalothin/cephalexin (24%).
- Resistance to first-generation cephalosporins is the highest reported in Australian pediatric UTIs.
Conclusions:
- Ampicillin/amoxycillin and cephalothin/cephalexin may be suboptimal for empiric UTI treatment in Australian children.
- These findings highlight the need to review and update antibiotic prescribing guidelines for pediatric UTIs.
Objective:
To describe the antibiotic resistance pattern of bacteria causing urinary tract infection (UTI) in a cohort of Australian children under 6 years of age.
Methods:
Data were collected over a 12-month period from children under 6 years of age with a provisional diagnosis of UTI made in the Emergency Department of Sunshine Hospital, Victoria.
Results:
During the study period 100 culture-proven UTI were identified in 97 children. Three children had two episodes. Out of the 100 episodes, 39% were male, 56% were under 12 months of age at presentation and 61% were managed as outpatients. Clinical features were non-specific in the majority of cases. Hydronephrosis and vesicoureteric reflux was detected in 5.5% and 28.6%, respectively, of children with their first investigated UTI. A single bacterial isolate was cultured from 97 urines and two from three samples. Escherichia coli (n = 90) and Proteus mirabilis (n = 5) were the most common isolates. In vitro resistance to ampicillin/amoxycillin was found in 52% of isolates, to trimethoprim in 14% and to cephalothin/cephalexin in 24%. This resistance rate to first generation cephalosporins is the highest reported to date in adult or paediatric UTI in Australia.
Conclusions:
Ampicillin/amoxycillin or cephalothin/cephalexin may not be the optimal choice of antibiotic for the empiric treatment of UTI in this and possibly other paediatric populations.
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