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Antimicrobial misuse in pediatric urinary tract infections: recurrences and renal scarring
Jayaweera Arachchige Asela Sampath Jayaweera1, Mohommed Reyes2
1Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka. jaas820703@yahoo.com.
Insights
Urinary tract infections (UTIs) in children are common, with early antimicrobial use potentially leading to resistant bacteria. Recurrent UTIs can cause kidney scarring, highlighting the need for targeted treatment strategies.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Clinical pharmacology
Background:
- Urinary tract infection (UTI) is a frequent bacterial infection in children.
- This study investigated uropathogens, antimicrobial susceptibility, and factors contributing to recurrent UTIs and renal scarring in pediatric patients.
- Children initially managed by general practitioners were later referred to a tertiary care setting.
Purpose of the Study:
- To identify uropathogens and their antimicrobial susceptibility patterns in children with UTI.
- To determine pathogens associated with recurrent UTIs (R-PN) and renal scarring (RS).
- To analyze the impact of prior antimicrobial exposure and general practitioner consultations on UTI management.
Main Methods:
- Collected urine cultures and antimicrobial susceptibility data for each UTI episode.
- Gathered 6-month histories of infections and antimicrobial use.
- Assessed in vitro biofilm formation in children with recurrent pyelonephritis.
Main Results:
- UTI frequency was higher in infants (p=0.03).
- All children (220) received antimicrobials in the 6 months prior; Cefixime was most common (p=0.02).
- 64.5% of children with UTI saw GPs before tertiary care (p=0.02). Urine isolates shifted to ESBL E. coli and K. pneumoniae over time. R-PN occurred in 36/208 participants; RS was detected in 22/70 pyelonephritis patients. New scarring occurred post-R-PN (11%, p=0.02). Biofilm formation was linked to R-PN (p=0.04).
Conclusions:
- Empirical antimicrobial use, especially third-generation cephalosporins, contributes to ESBL and CRE development.
- Antimicrobial prescribing should align with local epidemiology and susceptibility patterns.
- Recurrent pyelonephritis in childhood can lead to renal scarring, with biofilm formation playing a role in recurrence.
Background:
In children, urinary tract infection (UTI) is one of a common bacterial infection. This study was conducted to detect the uropathogen, antimicrobial susceptibility, pathogen associated with recurrences and renal scarring in children initially taken care from general practitioners and later presented to tertiary care.
Methods:
Every inward UTI episode, culture and antimicrobial susceptibility was done while on past 6-month, history of infections and use of antimicrobials was collected using clinical records and demonstration of antimicrobials. Children with recurrent pyelonephritis was followed and in vitro bio film formation was assessed.
Results:
Frequency of UTI was significantly high among infants (p = 0.03). Last 6-month, all (220) were exposed to antimicrobials. Cefixime was the commonly prescribed antimicrobial (p = 0.02). In current UTI episode, 64.5% (142/220) of children with UTI were consulted GPs' prior to seek treatment from tertiary care pediatric unit (p = 0.02). While on follow up child who developed UTI, found urine culture isolates were significantly shifted from E. coli and K. pneumoniae to extended spectrum of beta-lactamase (ESBL) E. coli and K. pneumoniae. Out of 208 participants, 36 of them had re-current pyelonephritis (R-PN). Renal scarring (RS) was detected in 22 out of 70 patients with pyelonephritis following dimercaptosuccinic acid scan. Following each episodes of recurrent pyelonephritis 11% of new scar formation was detected (p = 0.02). Bio film forming E. coli and K. pneumoniae was significantly associated in patients with R-PN (p = 0.04).
Discussion:
Medical care providers often prescribe antimicrobials without having an etiological diagnosis. While continuing exposure of third generation cephalosporin and carbapenem leads to development of ESBL and CRE microbes in great. The empiric uses of antimicrobials need to be stream lined with local epidemiology and antimicrobial susceptibility pattern. R-PN in childhood leads to RS. In great, bio film formation act as the focus for such recurrences.
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