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Urinary Tract Infections in Children: Changing Trends in Etiology and Local Resistance Patterns over a Three-Year
Patrícia Sousa1, Lucinda Delgado1, Susana Correia-de-Oliveira1
1Serviço de Pediatria. Hospital Senhora da Oliveira. Guimarães. Portugal.
Insights
Switching to cefuroxime for pediatric urinary tract infections reduced amoxicillin-clavulanate resistance. Cefuroxime resistance remained low, indicating a successful change in empirical antibiotic therapy for common childhood infections.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance
- Clinical microbiology
Background:
- Urinary tract infections (UTIs) are prevalent in children.
- Local antibiotic resistance data is vital for effective empirical treatment.
- This study evaluated changes in UTI pathogens and resistance following a guideline update.
Purpose of the Study:
- To review common uropathogens in pediatric UTIs.
- To analyze local antibiotic resistance patterns.
- To assess the impact of switching first-line empirical antibiotic regimens.
Main Methods:
- A cross-sectional study compared pediatric UTI cases from 2019 and 2022.
- An internal guideline recommended cefuroxime as the first-line empirical treatment from 2019 to 2022.
- Uropathogens, antibiotic choices, and resistance patterns were compared between the two periods.
Main Results:
- Escherichia coli was the most frequent pathogen (79.4-83.3%).
- Cefuroxime replaced amoxicillin-clavulanate (A-C) as the primary empirical antibiotic.
- Resistance to A-C showed a decreasing trend (33.1% to 27.4%), while cefuroxime resistance remained low (4.7% to 3.3%).
Conclusions:
- E. coli is the dominant pathogen in pediatric UTIs.
- The shift to cefuroxime led to a reduction in amoxicillin-clavulanate resistance.
- Cefuroxime demonstrated sustained low resistance, supporting its use in empirical UTI treatment.
Introduction:
Urinary tract infections are common in pediatrics. Knowledge of local resistance patterns is crucial to guide empirical antibiotic therapy. We aimed to review the pathogens implicated in urinary tract infections, local resistance patterns, and the impact of switching first-line empirical antibiotic regimens.
Methods:
We conducted a cross-sectional study including pediatric patients performing urine cultures in a hospital in northern Portugal over two periods: 2019 (group 1) and 2022 (group 2). Between time periods, an internal guideline was implemented recommending cefuroxime as the first-line choice for empirical treatment of urinary tract infections, according to local resistance patterns. Uropathogens, empirical antibiotic choices and resistance patterns were compared among groups.
Results:
The final sample included 402 cases of urinary tract infections in group 1 and 398 in group 2. Escherichia coli was the most common uropathogen (79.4 - 83.3%), followed by Proteus mirabilis and Klebsiella spp. The most common empirical antibiotic in group 1 was amoxicillin-clavulanate (A-C), as opposed to cefuroxime in group 2 (p < 0.001). The most common resistance was to ampicillin (39.3% - 39.7%). Resistance to A-C slightly decreased (33.1% vs 27.4%, p = 0.079), while resistance to cefuroxime (4.7% vs 3.3%, p = 0.292) and trimethoprim-sulfamethoxazole (TMP-SMX) remained similar (15.2% vs 14.1%, p = 0.659). Resistances to nitrofurantoin (9.0% vs 0.3%, p < 0.001) and fosfomycin (1.7% vs 0.3%, p < 0.036) significantly decreased from group 1 to group 2.
Conclusion:
E.coli remains the predominant pathogen in pediatric urinary tract infections. Resistance to A-C in our sample was high (33.1%). The switch from A-C to cefuroxime as first-line agent resulted in a decreasing trend in A-C resistance, while cefuroxime resistance remained low and even slightly lower.
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