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Uropathogen resistance to antibiotic prophylaxis in urinary tract infections
Hassib Narchi1, Muhaned Al-Hamdani
1Department of Paediatrics, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates. hassib.narchi@uaeu.ac.ae
Insights
Antibiotic resistance is common in children with recurrent urinary tract infections, with over half showing resistance to prescribed prophylaxis. This highlights potential issues with long-term antibiotic use and treatment effectiveness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Recurrent urinary tract infections (UTIs) in young children often necessitate long-term antibiotic prophylaxis.
- This preventative strategy carries an increased risk of developing resistant infections.
Purpose of the Study:
- To analyze the pattern of uropathogen resistance to prophylactic antibiotics in children experiencing recurrent UTIs.
- To assess the prevalence of multidrug resistance in these pediatric patients.
Main Methods:
- A cohort study involving 36 children aged 2 weeks to 10 years with recurrent UTIs.
- Antimicrobial susceptibility testing using the disc diffusion technique on isolated uropathogens.
- Analysis of resistance patterns to commonly prescribed prophylactic antibiotics like cefradine and cotrimoxazole.
Main Results:
- Uropathogen resistance to prophylactic antibiotics was observed in 53% of the children studied.
- Escherichia coli was the most frequent organism identified (72%).
- Multidrug resistance was prevalent in 55.5% of resistant cases, particularly against cephalosporins and cotrimoxazole.
Conclusions:
- Significant uropathogen resistance to long-term antibiotic prophylaxis occurs in children with recurrent UTIs.
- The high rate of resistance, including multidrug resistance, questions the sustained efficacy of current prophylactic regimens.
- Poor compliance with long-term prophylaxis may be a contributing factor in cases without observed antibiotic resistance.
Abstract:
Young children at risk of recurrent urinary tract infections are prescribed long-term antibiotic prophylaxis to prevent recurrences. As this is associated with an increased risk of resistant infections, we have analyzed the pattern of uropathogen resistance to the prescribed prophylactic antibiotic during a urinary tract infection recurrence. A cohort of 36 children aged 2 weeks to 10 years. Antimicrobial susceptibility of the isolates was tested by the disc diffusion technique. The majority were on prophylaxis with cefradine (n = 19, 53%) or cotrimoxazole (n = 11, 31%). Escherichia coli was the commonest grown organism (n = 26, 72%). Resistance occurred in 19 children (53%), with the highest for amoxicillin-clavulanate (n = 2, 100%) and nalidixic acid (n = 1, 100%), followed by cefradine (n = 10, 72%), cotrimoxazole (n = 5, 62%), and aminopenicillins (n = 1, 50%). Multidrug resistance occurred in 20 (55.5%) more commonly with cephalosporins (60% of cases) and cotrimoxazole (20%). Uropathogen resistance to prophylactic antibiotics occurs in 50% of the cases, half of which to multidrugs. Compliance to long-term prophylaxis seems to remain an important problem in the children where there was no resistance to the prescribed antibiotic.
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