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Changes in bacterial resistance patterns in children with urinary tract infections on antimicrobial prophylaxis at
Tanja Ilić1, Sanda Gračan, Adela Arapović
1School of Medicine, University of Split, Split, Croatia.
Insights
This study found high resistance rates in pediatric urinary tract infections (UTIs), particularly E. coli. Researchers recommend reconsidering certain antibiotics for long-term antimicrobial prophylaxis (LTAP) due to increasing resistance.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance
- Clinical microbiology
Background:
- Urinary tract infections (UTIs) are common in hospitalized children.
- Assessing uropathogen prevalence and antimicrobial agent (AA) resistance is crucial for effective treatment.
- Understanding resistance patterns informs antimicrobial stewardship.
Purpose of the Study:
- To determine the prevalence and antimicrobial resistance patterns of uropathogens in hospitalized children with UTIs.
- To compare resistance in children with single vs. repeated hospitalizations and those with urinary system (US) anomalies.
- To evaluate the impact of long-term antimicrobial prophylaxis (LTAP) on resistance.
Main Methods:
- Retrospective analysis of urine cultures (UC) from hospitalized children over a 7-year period.
- Comparison of patient groups: single vs. repeated hospitalizations, presence/absence of US anomalies, and LTAP use.
- Analysis of antimicrobial resistance rates for common uropathogens against various antimicrobial agents.
Main Results:
- Escherichia coli (E. coli) was the most common uropathogen (67.7%), showing high resistance to ampicillin (69.5%) and significant resistance to trimethoprim/sulfamethoxazole (TMP-SMX) (27.5%).
- Patients with US anomalies or repeated hospitalizations had a higher prevalence of Pseudomonas sp. and Klebsiella sp.
- E. coli in patients receiving LTAP exhibited higher resistance to ampicillin, amoxicillin/clavulonic acid, and TMP-SMX.
Conclusions:
- Ampicillin should be excluded for UTI treatment in this region.
- Reconsideration of TMP-SMX, nitrofurantoin, cephalexin, and amoxicillin/clavulonic acid for LTAP is recommended due to resistance trends.
- Tailoring antimicrobial strategies based on local resistance patterns is essential for pediatric UTIs.
Background:
We assessed prevalence and resistance of uropathogens on antimicrobial agents (AA) from urine cultures (UC) in children hospitalized with urinary tract infections (UTI) at University Hospital in Split.
Material/Methods:
During the 7-year period, children hospitalized only once with UTI alone were compared to those repeatedly hospitalized, and who received long-term antimicrobial prophylaxis (LTAP), as well as those with associated anomalies of the urinary system (US).
Results:
E. coli was the most frequent isolate (67.7%) with resistance to ampicillin by 69.5%, amoxicillin/clavulonic acid by 3.5%, cephalexin by 6.6%, trimethoprim/sulfamethoxazole (TMP-SMX) by 27.5%, and nitrofurantoin by 0.4%. For other uropathogens, AA resistance rates were the following: 64.3%, 5.8%, 10.5%, 21.3%, and 7.9%. The high or increasing resistance to TMP-SMX is characterized by all uropathogens. Patients with anomalies of US showed a lower prevalence of E. coli and Enterococcus sp., but a higher prevalence of Pseudomonas sp., ESBL-producing E. coli and Klebsiella sp. than those without US anomalies. Repeatedly hospitalized patients showed a lower prevalence of E. coli, but a higher prevalence of Pseudomonas sp. and Klebsiella sp. than patients hospitalized only once. Both groups displayed significantly less resistance of Enterococcus sp. In patients receiving LTAP before hospitalization, E. coli was significantly more resistant to ampicillin, amoxicillin/clavulonic acid and TMP/SMX than in those without LTAP.
Conclusions:
Based on our results, we recommend excluding ampicillin altogether, and reconsideration of further use of TMP-SMX, as well as use of nitrofurantoin, cephalexin and amoxicillin/clavulonic acid for LTAP in our region.
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