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Escherichia coli resistance to amoxiclavulanate therapy in pediatric urinary tract infections: a rising problem
Ilaria Possenti1, Giovanni R Pieri2, Lara Calcagno3
1Pediatrics and Pediatric Emergency Unit, Children Hospital, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Insights
Pediatric urinary tract infections (UTIs) show increasing resistance to amoxicillin-clavulanate, a common first-line treatment. This trend highlights the need for ongoing surveillance of antibiotic resistance in children.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Antimicrobial resistance surveillance
Background:
- Urinary tract infections (UTIs) are common in children, frequently caused by Escherichia coli.
- Evaluating antimicrobial susceptibility trends is crucial for effective pediatric UTI management.
Purpose of the Study:
- To assess the antimicrobial susceptibility patterns of bacterial isolates from pediatric urine cultures over a six-year period.
- To identify trends in antibiotic resistance relevant to the management of childhood UTIs.
Main Methods:
- Retrospective analysis of 1299 urine cultures collected between 2015 and 2020.
- Data included patient demographics and laboratory findings, focusing on positive cultures and antibiograms.
- Statistical analysis compared antimicrobial resistance trends between two-year periods.
Main Results:
- Escherichia coli was the predominant isolate (74.2%) in 577 positive urine cultures.
- A statistically significant increase in amoxicillin-clavulanate resistance was observed in E. coli isolates from 2019-2020 compared to 2015-2018.
- This indicates a growing challenge in treating common pediatric UTIs.
Conclusions:
- Current first-line recommendations for amoxicillin-clavulanate in pediatric UTIs may require re-evaluation.
- Local antibiotic resistance surveillance is essential for optimizing therapeutic strategies in pediatric populations.
- The findings underscore the need for updated treatment guidelines based on evolving resistance patterns.
Background:
Urinary tract infections (UTIs) are a frequent disorder of childhood, mainly caused by Escherichia coli. The aim of this study was to evaluate the antimicrobial susceptibility trend in bacterial isolates in urine cultures in pediatric environment, analyzing data from our laboratory in a 6-year period.
Methods:
A retrospective study was performed in AO SS. Antonio e Biagio e Cesare Arrigo (Pediatric Hospital) of Alessandria in Piedmont, North Ital. From 2015 to 2020, in a 6-year period, 1299 urinocultures were collected. Data collection was focused on demographic characteristics (age and sex) and laboratory findings (positive urocultures, antibiogram).
Results:
Positive urocultures were 577, in which Escherichia coli represented most isolates (428, 74.2%). We found a statistically significant trend toward amoxiclavulanate resistance in the E. coli positive urinoculture comparing the period 2015-2018 vs. 2019-2020.
Conclusions:
Actual guidelines mostly recommend for amoxicillin-clavulanate prescription as first-line option for pediatric UTI management, this indication might be partially reconsidered. Our data underline the importance to conduct surveillance studies to determine local prevalence of antibiotic resistance to optimize therapeutic management.
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