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Resistance against broad-spectrum beta-lactams among uropathogens in children

Maria Bitsori1, Sofia Maraki, Maria Kalmanti

  • 1Department of Paediatrics, University Hospital of Heraklion, POB 1352, Heraklion 71500, Greece. bitmar@hol.gr

Pediatric Nephrology (Berlin, Germany)
|July 29, 2009
PubMed

Insights

Urinary tract infections (UTIs) caused by broad-spectrum beta-lactam resistant Enterobacteriaceae are increasing in children. Risk factors include male gender, urinary abnormalities, and prior antibiotic use, limiting treatment options.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Clinical Microbiology

Background:

  • Urinary tract infections (UTIs) are common in children.
  • The rise of antimicrobial resistance poses a significant threat to effective treatment.
  • Enterobacteriaceae are frequent causes of UTIs, and resistance to broad-spectrum beta-lactams is a growing concern.

Purpose of the Study:

  • To investigate the prevalence trends of Enterobacteriaceae resistant to broad-spectrum beta-lactams in pediatric UTIs.
  • To identify risk factors associated with these resistant infections.
  • To understand the implications for antibiotic treatment and prophylaxis strategies.

Main Methods:

  • Retrospective analysis of Enterobacteriaceae isolates from children under 15 years old.
  • Data collected over an 11-year period (1997-2007).
  • Phenotypic resistance testing and evaluation of clinical risk factors.

Main Results:

  • Prevalence of resistance to broad-spectrum beta-lactams among Enterobacteriaceae increased significantly over the study period (p = 0.031).
  • Of 523 isolates, 30 (5.73%) were resistant; common species included Escherichia coli and Klebsiella spp.
  • Resistant infections were frequently community-acquired (73.3%) and associated with male gender, urinary tract abnormalities, prophylactic antibiotics, longer hospitalization, and recurrent UTIs.

Conclusions:

  • There is an increasing prevalence of community-acquired Enterobacteriaceae resistant to broad-spectrum beta-lactams in children.
  • This resistance limits the effectiveness of first-line antibiotics for UTIs.
  • The findings question the routine use of antibiotic prophylaxis after a first UTI episode due to the risk of selecting for resistant organisms.

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