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[Practical problems related to the management of febrile urinary tract infection in Vietnamese children]
H P Duong1, T T Mong Hiep1, D T Hoang1
1Département de néphrologie pédiatrique, hôpital Nhi Dong 2, université Pham Ngoc Thach, 14, Ly Tu Trong, Quận 1, Hô-Chi-Minh, Viet Nam.
Insights
Urinary tract infections (UTIs) in Vietnamese children are often caused by resistant E. coli. A new empiric treatment is proposed due to high rates of antibiotic resistance and extended-spectrum β-lactamase (ESBL) production.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Urinary tract infections (UTIs) pose significant management challenges in febrile Vietnamese children.
- Understanding local etiological patterns and antimicrobial resistance is crucial for effective UTI treatment.
Purpose of the Study:
- To describe practical challenges in managing UTIs among febrile children in Vietnam.
- To evaluate the effectiveness of current antibiotic protocols and propose improvements.
Main Methods:
- Prospective study of 143 febrile children with UTI in Ho Chi Minh City over 28 months.
- Treatment followed a local protocol: parenteral ceftriaxone, followed by oral cefixime.
- Antibiotic therapy was adjusted only for clinical non-response, irrespective of antibiogram results.
Main Results:
- Escherichia coli was the predominant pathogen (80%), with high resistance to ampicillin (91%) and cotrimoxazole (74%).
- Extended-spectrum β-lactamase (ESBL) production was prevalent in 52% of Enterobacteriaceae.
- Initial ceftriaxone treatment was inappropriate in 63% of cases based on susceptibility.
Conclusions:
- High prevalence of antibiotic-resistant E. coli and ESBL-producing bacteria necessitates revised UTI treatment guidelines.
- Current empiric antibiotic strategies are often inadequate for Vietnamese children with suspected UTI.
- A new empiric treatment schedule is proposed to improve UTI management outcomes.
Background:
To describe the practical problems related to urinary tract infection (UTI) management in febrile Vietnamese children.
Methods:
During a prospective 28-month inclusion period, 143 febrile children with significant bacteriuria were treated for UTI in the nephrology department of Nhi Dong 2 children's hospital in Ho Chi Minh City, Vietnam. Patients were treated after blood and urine samples had been taken for culture, according to a local antibiotic protocol, parenterally with ceftriaxone 75mg/kg/day. Oral treatment with cefixime 8mg/kg/day was started after 48h of apyrexia for 2 weeks. According to local protocol, antibiotic therapy was only changed if children did not respond clinically to treatment regardless of antibiogram results.
Results:
Among these 143 children, 51% were girls and 80% of them had their first UTI before the age of 2 years. The commonest causative agent was Escherichia coli (80% of cases) with a high resistance rate to ampicillin (91%) and cotrimoxazole (74%). Extended-spectrum β-lactamase (ESBL) production was observed in 52% of Enterobacteriaceae isolates. According to antibiotic susceptibility, the initial treatment with ceftriaxone was found to be inappropriate in 63% of cases.
Conclusions:
E. coli was responsible for 80% of UTIs in Vietnamese children with a high rate of resistance to first-line antibiotics. ESBL production was found to be extremely high in this study. Based on these data, we propose a new empiric treatment schedule for Vietnamese children suspected of UTI.
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