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Rising resistance of urinary tract pathogens in children: a cause for concern
Mansoor Ahmed1, Wan Norafifah Wan Long2, Sidra Javed2
1Department of Paediatrics, Queen's Hospital, Belvedere Road, Burton upon Trent, UK. mansoor.ahmed2@nhs.net.
Insights
This study tracked antibiotic resistance in childhood urinary tract infections (UTIs). While resistance to Amoxicillin and Trimethoprim remains high, Nitrofurantoin resistance decreased, and Cefalexin resistance increased, necessitating careful antibiotic selection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) are common in children, and prompt treatment is crucial to prevent complications.
- Antibiotic resistance in uropathogens is a growing concern, influenced by regional prescribing patterns.
- Rational antibiotic use is key to minimizing the emergence of resistant bacteria.
Purpose of the Study:
- To investigate the antibiotic resistance patterns of common uropathogens causing UTIs in children.
- To compare current resistance trends with historical data to identify changes over time.
Main Methods:
- A retrospective analysis of culture-proven UTI cases in children under 16 years old between 2009 and 2019.
- Comparison of resistance data with a previous period (2002-2008).
Main Results:
- E. coli was the predominant uropathogen, found in 94% of samples.
- High resistance rates persisted for Amoxicillin and Trimethoprim.
- Nitrofurantoin resistance significantly decreased from 10% to 5.84%.
- Cefalexin resistance notably increased from 7.4% to 14.56%.
Conclusions:
- Cefalexin is cautiously recommended for empirical treatment of uncomplicated UTIs in secondary care, pending culture results.
- Nitrofurantoin should be reserved for specific cases, such as non-E. coli UTIs or multi-drug resistant infections.
- Continuous monitoring of antibiotic resistance patterns is essential for all regions to guide appropriate treatment strategies.
Background:
Urinary tract infection (UTI) is one of the common infections in childhood. Prompt diagnosis and treatment reduces the risk of complications. The choice of antibiotic to treat UTI varies from region to region. Rational use and appropriately chosen antibiotic reduces the emergence of resistant uropathogens.
Objective:
We investigated the resistance pattern of uropathogens for commonly used antibiotics to treat UTI locally.
Methods:
Data was collected between 2009 and 2019 on all infants and children under 16 years of age with culture proven UTI. Results were compared with previously published figures between 2002 and 2008.
Results:
A total of 1002 samples were analysed (91/year). Male to female ratio was 1:4.6. About 94% of the samples grew E. coli. As before, high resistance rates were recorded to Amoxicillin and Trimethoprim (Z = -0.325: P = 0.7452; not significant). Overall, average resistance has decreased for Nitrofurantoin from 10% between 2002 and 2008 to 5.84% between 2009 and 2019 (Z = 3.002: P = 0.0027). On the other hand, Cefalexin resistance has increased from 7.4 to 14.56% between the two study periods (Z = -4.2: P = < 0.0002).
Conclusion:
Despite rising resistance rates, we recommend that Cefalexin should cautiously remain the antibiotic of choice for empirically treating uncomplicated urinary tract infections in secondary care pending urine culture. Nitrofurantoin should be reserved for treating non-coliform/atypical UTIs or multi-drug resistant UTIs. There is an ongoing need for clinicians in all geographic regions to continue to monitor antibiotic resistance rates every few years.
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