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[Bacterial pathogens, resistance patterns and treatment options in community acquired pediatric urinary tract
1Abteilung für pädiatrische Nephrologie und Stoffwechselerkrankungen, Medizinische Hochschule Hannover.
Insights
Pediatric urinary tract infection (UTI) bacterial resistance patterns vary regionally. In northern Germany, resistance to certain antibiotics like cotrimoxazole and first-generation cephalosporins increased, necessitating updated treatment guidelines.
Area of Science:
- Pediatric infectious diseases
- Bacteriology
- Antimicrobial resistance
Background:
- Urinary tract infections (UTIs) in children exhibit significant regional variations in causative pathogens and antibiotic resistance.
- Changing resistance patterns necessitate updated treatment strategies.
Purpose of the Study:
- To evaluate the epidemiology and antibiotic resistance patterns of bacterial pathogens causing community-acquired UTIs in children in northern Germany.
- To inform local treatment guidelines based on current resistance data.
Main Methods:
- A retrospective analysis of urine cultures from 100 children (mean age 4.4 years) diagnosed with community-acquired UTI between 2000-2002.
- Inclusion criteria included acute voiding symptoms, significant bacteriuria, and leukocyturia; exclusion criteria involved renal or urinary tract abnormalities, age <2 months, and recurrent UTIs.
Main Results:
- Escherichia coli was the most common pathogen (47%), followed by Enterococcus faecalis (23%).
- High resistance rates were observed for Ampicillin (69% in E. coli) and Cotrimoxazole (42% in E. coli).
- Resistance to first-generation cephalosporins increased by approximately 20% compared to previous data.
Conclusions:
- While resistance to Ampicillin (+/- Sulbactam) remained stable, significant increases in resistance to Cotrimoxazole and first-generation cephalosporins were noted.
- Local antibiotic resistance patterns for pediatric UTIs should be re-evaluated every five years to guide treatment policies.
Background:
Epidemiology and resistance patterns of bacterial pathogens in pediatric UTI show large interregional variability and rates of bacterial resistances are changing due to different antibiotic treatment. We intended to evaluate data from northern Germany.
Patients And Methods:
In 100 children (53 female, 47 male, mean age 4.4 +/- 4.2 years) with community acquired UTI, who presented in the emergency department of our medical school from 2000 - 2002, urine cultures were performed. Inclusion criteria were: acute voiding symptoms, significant bacteriuria with growth of at least 10 (5) colony-forming units/ml urine, leukocyturia > 50/ micro l. Exclusion criteria were underlying renal diseases, anatomic abnormalities of the urinary tract, age < 2 months and recurrent UTI.
Results:
Patients presented with a mean rectal temperature of 38.6 +/- 1.3 degrees C, mean CRP of 66 +/- 68 mg/dl, mean WBC 13 500 +/- 5 600/ micro l and mean urinary leukocytes of 425 +/- 363/ micro l. In urine cultures E. coli was found in 47 % of the cases, Enterococcus faecalis 23 %, Proteus mirabilis 8 %, Klebsiella oxytoca 4 %, Pseudomonas aeruginosa 5 % and others 13 %. In 76 % one and in 24 % two different bacterial species (60 % Enterococcus faecalis) were cultured. Mean resistance rates were in all bacteria (in E. coli): Ampicillin 53 % (69 %), Ampicillin and Sulbactam 51 % (61 %), Cefalosporin 1 (st) generation (Cefaclor) 48 % (24 %), Cefalosporin 2 (nd) generation (Cefuroxim) 40 % (3 %), Cefalosporin 3 (rd) generation (Cefuroxim) 33 % (0 %), Tobramycin 30 % (2 %), Ciprofloxacine 0 %, Cotrimoxazole 40 % (42 %), Nitrofurantoin 12 % (0 %).
Conclusion:
The resistance rates to Ampicillin (+/- Sulbactam) did not increase as compared to previous analyses (1990 - 1995), however, resistance rates to Cotrimoxazole and 1 (st) generation Cefalosporines increased about 20 %. We conclude that the policies for treatment of UTI in children should be re-evaluated every 5 years according to local resistance rates.
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