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Resistance Patterns from Urine Cultures in Children Aged 0 to 6 Years: Implications for Empirical Antibiotic Choice

Carlotta Montagnani1, Chiara Tersigni2, Sara D'Arienzo3

  • 1Infectious Disease Unit, Meyer Children's University Hospital, Florence, Italy.

Infection and Drug Resistance
|June 30, 2021
PubMed

Insights

Urinary tract infections (UTIs) in children under six show high resistance to amoxicillin-clavulanate, especially in younger or hospitalized patients. Susceptibility remains high for other antibiotics, with no increased resistance linked to prior pediatrician prescriptions.

Area of Science:

  • Pediatric infectious diseases
  • Antimicrobial resistance surveillance
  • Bacteriology

Background:

  • Urinary tract infections (UTIs) are common in children, often caused by Gram-negative Enterobacterales.
  • Understanding etiological patterns and antimicrobial susceptibility is crucial for effective treatment.

Purpose of the Study:

  • To evaluate the etiology and antimicrobial susceptibility of bacterial isolates in pediatric UTIs.
  • To analyze the impact of prior hospitalization and antibiotic use on antimicrobial resistance rates.

Main Methods:

  • Retrospective study of 2944 positive urine cultures from 2445 children under six.
  • Data collected from 13 public laboratories in Tuscany, Italy, via the SMART surveillance system.

Main Results:

  • Escherichia coli was the most common isolate (54.2%), followed by Enterococcus faecalis (12.3%).
  • High resistance rates (>25%) to amoxicillin-clavulanate were observed, particularly in children under one year and those with recent hospitalization.
  • High susceptibility (>90%) to aminoglycosides, cephalosporins, and quinolones was noted. Previous antibiotic prescriptions did not correlate with increased resistance.

Conclusions:

  • A significant rate (25%) of amoxicillin-clavulanate resistance in pediatric UTIs was found.
  • Younger children and those with prior hospitalizations exhibited higher resistance.
  • Judicious use of amoxicillin-clavulanate is recommended for young children and those with severe UTI symptoms.
Abstract

Keywords:
antibiotic therapyantimicrobial resistanceinfanturinary tract infections

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