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Antibiotic treatment and antimicrobial resistance in children with urinary tract infections
K Vazouras1, K Velali2, I Tassiou3
1The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens, Athens, Greece; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London SW17 0RE, UK; Second Department of Pediatrics, Aghia Sophia Children΄s Hospital, Agia Sophia Hospital, Goudi, Athens, Greece.
Insights
Antibiotic prescribing for pediatric urinary tract infections (UTIs) showed high rates of amikacin and prolonged intravenous treatments. Escherichia coli exhibited significant resistance to ampicillin, highlighting the need for antimicrobial stewardship.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Pharmacy
Background:
- Urinary tract infections (UTIs) are common in children, necessitating appropriate antibiotic use.
- Antimicrobial resistance (AMR) poses a significant global health threat, particularly in pediatric populations.
- Understanding local prescribing patterns and resistance profiles is crucial for effective UTI management in children.
Purpose of the Study:
- To analyze antibiotic prescribing trends in hospitalized children diagnosed with febrile and afebrile UTIs.
- To determine the rates of antimicrobial resistance among common pathogens causing UTIs in pediatric patients.
- To evaluate the appropriateness of antibiotic selection and treatment duration for pediatric UTIs.
Main Methods:
- Retrospective analysis of antibiotic prescriptions and antibiograms for pediatric UTI patients over a 5-year period.
- Inclusion of neonates, infants, and older children admitted to a general district hospital.
- Antimicrobial susceptibility testing performed using the Kirby-Bauer disk diffusion method.
Main Results:
- Amikacin was the most frequently prescribed antibiotic (31.2%), followed by amoxicillin/clavulanic acid (17.4%) and ampicillin (13.5%).
- Prolonged intravenous treatment durations were observed for both febrile (5.4 days) and afebrile (4.4 days) UTIs.
- Escherichia coli, the predominant pathogen (79.2%), showed high resistance to ampicillin (42.0%) and trimethoprim/sulfamethoxazole (26.5%), but remained susceptible to third-generation cephalosporins and amikacin.
Conclusions:
- High rates of amikacin and penicillin-based antibiotic prescriptions, along with extended intravenous therapies, were noted.
- Third-generation cephalosporins demonstrated better in vitro efficacy against Escherichia coli compared to ampicillin.
- Implementing antimicrobial stewardship programs and continuous AMR monitoring is recommended to optimize antibiotic prescribing for pediatric UTIs.
Objectives:
The aim of this study was to describe antibiotic prescribing patterns and antimicrobial resistance rates in hospitalised children with febrile and afebrile urinary tract infections (UTIs).
Methods:
Antibiotic prescriptions and antibiograms for neonates, infants and older children with UTI admitted to a general district hospital in Central Greece were evaluated. Data covering a 5-year period were collected retrospectively from the Paediatric Department's Electronic Clinical Archive. Patients were included based on clinical and microbiological criteria. Antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method.
Results:
A total of 230 patients were included in the study. Among 459 prescriptions identified, amikacin (31.2%) was the most common antibiotic prescribed in this population, followed by amoxicillin/clavulanic acid (17.4%) and ampicillin (13.5%). Children received prolonged intravenous (i.v.) treatments for febrile (mean ± S.D., 5.4 ± 1.45 days) and afebrile UTIs (mean ± S.D., 4.4 ± 1.64 days). A total of 236 pathogens were isolated. The main causative organism was Escherichia coli (79.2%) with high reported resistance rates to ampicillin (42.0%), trimethoprim/sulfamethoxazole (26.5%) and amoxicillin/clavulanic acid (12.2%); lower resistance rates were identified for third-generation cephalosporins (1.7%), nitrofurantoin (2.3%), ciprofloxacin (1.4%) and amikacin (0.9%). Klebsiella spp. isolates were highly resistant to cefaclor (27.3%).
Conclusion:
High prescribing rates for amikacin and penicillins (± β-lactamase inhibitors) and prolonged i.v. treatments were observed. Escherichia coli was highly resistant to ampicillin, whilst third-generation cephalosporins exhibited greater in vitro efficacy. Establishment of antimicrobial stewardship programmes and regular monitoring of antimicrobial resistance could help to minimise inappropriate prescribing for UTIs.
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