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Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group
Irene Alberici1, Aysun Karabay Bayazit, Dorota Drozdz
1Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy, ire.alberici@gmail.com.
Insights
Urinary tract infections (UTIs) in infants are commonly caused by Escherichia coli, but other bacteria are also frequent. Antibiotic prophylaxis for UTIs needs to be adaptable to maintain effectiveness.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Microbiology
Background:
- Effective management of urinary tract infections (UTIs) requires knowledge of causative organisms and their resistance patterns.
- Antibiotic prophylaxis is used in infants with kidney malformations.
Purpose of the Study:
- To survey pediatric nephrologists on positive urine cultures in infants under 24 months.
- To understand the spectrum of causative organisms and resistance patterns in infant UTIs.
Main Methods:
- Prospective online survey of pediatric nephrologists.
- Collected 4745 urine cultures from 18 units in 10 European countries (July 2010-June 2012).
- Analyzed bacterial isolates and their antibiotic resistance.
Main Results:
- Escherichia coli was the most frequent isolate, but not always dominant (<50% in some settings).
- Other common bacteria included Klebsiella, Enterococcus, Proteus, and Pseudomonas.
- E. coli showed high resistance to amoxicillin and trimethoprim; nitrofurantoin demonstrated good efficacy with low resistance.
Conclusions:
- While E. coli is common, diverse bacterial strains cause infant UTIs.
- Antibiotic prophylaxis strategies for infant UTIs must be flexible and adaptable to changing resistance patterns.
Unlabelled:
Knowledge of the distribution spectrum of causative organisms and their resistance patterns has become a core requirement for the rational and effective management of urinary tract infections. In the context of a prospective trial on the use of antibiotic prophylaxis in infants with underling kidney malformations, we conducted an online survey among paediatric nephrologists on positive urine cultures (July 2010-June 2012) from both hospitalized and non-hospitalized infants under 24 months of age. We collected 4745 urine cultures (UCs) at 18 units in 10 European countries. Escherichia coli was the most frequent bacterium isolated from UCs; however, in 10/16 hospitals and in 6/15 community settings, E. coli was isolated in less than 50% of the total positive UCs. Other bacterial strains were Klebsiella, Enterococcus, Proteus and Pseudomonas not only from hospital settings. E. coli showed a high resistance to amoxicillin and trimethoprim and variable to cephalosporin. Nitrofurantoin had a good rate of efficacy, with 11/16 hospitals and 11/14 community settings reporting a resistance lower than 5%.
Conclusion:
E. coli is the most common organism causing UTIs in infants; however, other bacterial strains are frequently isolated. As a result, antibiotic prophylaxis should be more elastic and adaptable over time in order to guarantee maximum efficacy.