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Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania
Carmen Duicu1, Iulia Cozea2, Dan Delean3
1Department of Pediatrics, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Târgu Mureş, Romania.
Insights
Pediatric urinary tract infections (UTIs) show high resistance to common antibiotics. Nitrofurantoin, ceftriaxone, amikacin, and carbapenem are recommended for empirical treatment of complicated UTIs in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Urinary tract infections (UTIs) are common bacterial infections in children.
- Increasing incidence of UTIs caused by resistant bacterial strains, including extended-spectrum β-lactamase-producing Enterobacteriaceae (about 15% of cases).
Purpose of the Study:
- To determine the antibiotic resistance patterns of uropathogens in pediatric UTIs.
- To evaluate the association between antibiotic resistance and urinary tract abnormalities in children.
Main Methods:
- Retrospective study of 331 pediatric UTI cases.
- Analysis of uropathogen resistance to commonly prescribed UTI drugs.
- Assessment of multidrug-resistance (MDR) rates and correlation with urinary tract abnormalities.
Main Results:
- High resistance rates observed for ampicillin, amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX), cefuroxime, and ciprofloxacin in *E. coli* and *Klebsiella*.
- Multidrug-resistance (MDR) detected in one-third of uropathogens.
- Over half of MDR uropathogens were isolated from patients with urinary tract abnormalities.
Conclusions:
- Nitrofurantoin, ceftriaxone, amikacin, and carbapenem show potential for empirical treatment of febrile or complicated pediatric UTIs.
- Findings suggest modifying initial empiric UTI treatment protocols for infants based on local antimicrobial sensitivity.
- Highlights the need for ongoing monitoring of local uropathogen sensitivity to guide effective UTI treatment in children.
Abstract:
One of the most frequent bacterial infections in children are urinary tract infections (UTIs). In recent years, an increasing incidence of UTIs caused by resistant bacterial strains has been observed, especially with extended-spectrum β-lactamase-producing Enterobacteriaceae that represent about 15% of UTIs. A retrospective study was performed comprising 331 pediatric cases with UTI. Our study aimed to detect the resistance of the uropathogens to common drugs used in UTI treatment. High resistance rates have been recorded for ampicillin, amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX), cefuroxime, and ciprofloxacin, among E. coli and Klebsiella. The multidrug-resistance (MDR) rate was detected in one-third of the uropathogens, among which more than half were isolated in patients with urinary tract abnormalities. Our study highlighted that nitrofurantoin, ceftriaxone, amikacin and carbapenem may be used for the empirical treatment for febrile or complicated UTI in children. This is the first comprehensive study that evaluates antibiotic resistance in UTIs in children, and their association with urinary tract abnormalities in Romania. As a result of this research, the protocol for initial empiric treatment of infants with febrile or complicated UTI should be modified considering a detailed and ongoing monitoring of local sensitivity of uropathogens to antimicrobial agents.
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