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Community-acquired urinary tract pathogens and their resistance patterns in hospitalized children in southeastern
Charisse W Kwan1, Heather Onyett
1Department of Paediatrics, Queen's University, Kingston, Ontario.
Insights
Pediatric urinary tract infections show high resistance to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMX). Prior antibiotic use, genitourinary disease, and previous infections increase the risk of resistant bacteria in children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Epidemiology
Background:
- Urinary tract infections (UTIs) are common in children.
- Understanding bacterial epidemiology and antimicrobial resistance is crucial for effective treatment.
Purpose of the Study:
- To assess the epidemiology and resistance patterns of bacteria causing UTIs in pediatric patients admitted to Kingston General Hospital.
- To identify risk factors associated with antibiotic resistance in pediatric UTIs.
Main Methods:
- Retrospective chart review of pediatric patients (1-18 years) admitted with a UTI diagnosis between 2002 and early 2006.
- Analysis of urine culture data to identify common bacteria and their resistance patterns.
Main Results:
- Escherichia coli was the most common pathogen (71.6%), followed by Enterococcus (5.7%) and Klebsiella (5.0%).
- High resistance rates were observed for ampicillin (54.4%) and trimethoprim-sulfamethoxazole (TMP-SMX) (40.4%).
- Factors like prior antibiotic use, genitourinary disease, and previous UTI admissions were linked to increased bacterial resistance.
Conclusions:
- Ampicillin and TMP-SMX exhibit significant resistance in pediatric UTIs.
- Third-generation cephalosporins are recommended for high-risk patients, while ampicillin plus gentamicin may be considered for low-risk empirical therapy.
Background:
The purpose of the present study was to assess the epidemiology and resistance patterns of bacteria causing urinary tract infections in children who were admitted to Kingston General Hospital (Kingston, Ontario) - the regional tertiary care hospital of southeastern Ontario.
Methods:
A retrospective chart review of patients one to 18 years of age who were admitted to Kingston General Hospital with a discharge diagnosis of urinary tract infection between 2002 and early 2006 was undertaken.
Results:
One hundred forty-two patient charts were reviewed, of which 56.3% of patients were female. The mean age of the patients was 12.3 months. The most common bacteria identified on urine culture over a five-year period were Escherichia coli (71.6%), Enterococcus species (5.7%) and Klebsiella species (5.0%). Bacteria were frequently resistant to ampicillin (54.4%) and trimethoprim-sulfamethoxazole (TMP-SMX) (40.4%). During the three months before admission, bacteria resistant to ampicillin were cultured from the urine of 75.6% of patients who were receiving some antibiotic, compared with 44% of children with no documented use of antibiotics (P<0.0001). Resistance to TMP-SMX in those with pre-existing genitourinary disease was 72.2% versus 31.8% in those without (P<0.0001). Patients who had previous admissions for urinary tract infections also showed greater resistance to TMP-SMX (70.6% versus 32.7%; P<0.005), cefazolin (64.7% versus 20.0%; P<0.0001) and nitrofurantoin (58.8% versus 18.2%; P<0.0001).
Conclusions:
There was a high resistance to ampicillin. Risk factors for resistant bacteria included the use of antibiotics three months before admission, previous genitourinary disease and previous admissions for urinary tract infections. In the presence of these risk factors, a third-generation cephalosporin as first-line antimicrobial therapy is recommended. However, the combination of ampicillin plus gentamicin can be considered for empirical therapy in low-risk patients.
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