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Urinary Tract Infection in Pediatrics: Study of Uropathogens and Their Resistance in a Madrid Hospital
María Romo Rosado1, Adoración Granados Molina1, Almudena Lagares Velasco1
1Servicio de Pediatría, Hospital Universitario Infanta Elena, 28343 Madrid, Spain.
Insights
Antibiotic resistance in pediatric urinary tract infections (UTIs) is rising. Amoxicillin/clavulanate is no longer suitable for empirical therapy due to increased resistance in common uropathogens.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance
- Urology
Background:
- Antibiotic resistance poses a significant challenge in treating childhood urinary tract infections (UTIs).
- Understanding current antibiotic susceptibility patterns is crucial for effective empirical treatment strategies.
Approach:
- A retrospective study analyzed UTI episodes from two distinct periods (2008-2010 and 2017-2019).
- Data on patient demographics, clinical presentation, and causative uropathogens were reviewed.
- Antibiotic susceptibility/resistance patterns were evaluated over time.
Key Points:
- Escherichia coli was the most frequent uropathogen.
- Significant increase in resistance to amoxicillin/clavulanate observed between the study periods (12.2% to 24%).
- Resistance patterns remained stable for gentamicin and cotrimoxazole, with a slight increase for first-generation cephalosporins.
Conclusions:
- Increased resistance to amoxicillin/clavulanate renders it unsuitable for empirical UTI therapy in pediatric patients.
- First-generation cephalosporins represent an adequate alternative for empirical treatment in children without risk factors.
Introduction:
Resistance to antibiotics is a growing problem with repercussions on the choice of first-line treatment in urinary tract infection (UTI) in childhood.
Objectives:
To know the current pattern of antibiotic susceptibility/resistance of the most frequent germs that cause UTI in our healthcare area. Secondary objective is to know the evolution of these patterns over time.
Patients And Methods:
A cross-sectional retrospective study of UTI episodes in a first-level hospital in two periods: 1st January 2008-31th December 2010 and 1st January 2017-31th December 2019 through a review of medical records, recording the following variables: Age, sex, fever, hospital admission, uropathy/bladder dysfunction, antibiotic prophylaxis.
Results:
First period: 174 UTI episodes (156 patients); Second period: 266 UTI episodes (218 patients). The most frequently isolated germ was E. coli, but in patients with uropathy or bladder dysfunction, the percentage of different germs is greater. A significant increase in resistance to amoxicillin/clavulanate (from 12.2 to 24%) is observed between both periods, it remains stable and in an acceptable range for gentamicin, cotrimoxazole and slightly increases to first-generation cephalosporins. In patients with uropathy/bladder dysfunction, resistance to all these antibiotics is significantly increased.
Conclusions:
The increased resistance of the most frequent uropathogens in the UTI of the pediatric population of our healthcare area to amoxicillin/clavulanate makes it unsuitable as empirical therapy. First-generation cephalosporins are an adequate alternative in patients without risk factors.
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