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[Antibiotic treatment of urinary tract infections in hospitalized children]
M G Bianchetti1, D Markus-Vecerova, U B Schaad
1Medizinische Kinderklinik, Universität Bern.
Insights
Prompt parenteral administration of aminopenicillin and aminoglycosides is crucial for treating moderate to severe pediatric urinary tract infections, preventing kidney damage. This combination ensures broad pathogen coverage and effective treatment.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Pharmacology
Context:
- Retrospective analysis of 237 pediatric patients (1 week-15 years) with moderate to severe urinary tract infections (UTIs) treated between 1980-1991.
- Evaluated bacterial etiology, antimicrobial susceptibility, and drug management for UTIs.
- Identified 266 bacterial pathogens, with Escherichia coli being the most prevalent.
Purpose:
- To analyze bacterial etiology, in vitro antimicrobial susceptibility, and drug management in pediatric UTIs.
- To determine the most effective initial antimicrobial regimen for preventing renal tissue lesions.
- To guide optimal antibiotic selection for pediatric UTIs based on pathogen resistance patterns.
Summary:
- Escherichia coli was the most common pathogen (203 isolates), followed by Enterococcus (21) and Klebsiella (20).
- In vitro susceptibility showed high efficacy for aminoglycosides (92%) and co-trimoxazole (83%), with lower rates for aminopenicillins (61%).
- Initial parenteral therapy with aminopenicillin and aminoglycoside was administered to 105 patients, with a 13% modification rate.
Impact:
- Suggests that an initial parenteral regimen of aminopenicillin and aminoglycoside is essential for prompt urine and kidney sterilization in pediatric UTIs.
- Highlights the importance of appropriate antibiotic selection to prevent renal scarring and long-term complications.
- Provides evidence-based recommendations for managing severe pediatric UTIs, emphasizing combination therapy.
Abstract:
From 1980 to 1991 237 patients (aged 1 week to 15 years) with moderate to severe urinary tract infection had been treated at the Department of Pediatrics University of Berne, Switzerland. Bacterial etiology, antimicrobial in vitro susceptibility tests, and drug management were retrospectively analyzed. 266 bacterial pathogens were isolated from these patients. Escherichia coli was the most frequent etiologic agent (203), followed by Enterococcus (21), Klebsiella (20), Proteus (12), Pseudomonas (6), Enterobacter (2) and Serratia (2). The overall in vitro susceptibility of these isolates was 61% for aminopenicillins, 80% for co-amoxiclav, 83% for co-trimoxazole and 92% for aminoglycosides. Aminoglycosides were ineffective in vitro only against enterococci. However, since all enterococcal strains were always sensitive to aminopenicillins, none of the pathogens was concomitantly resistant to both aminoglycosides and aminopenicillins. Parenteral therapy had been given initially in 141 patients (59%); aminopenicillin and aminoglycoside in 105, and aminopenicillin alone in 36 cases (cefuroxime instead of aminopenicillin in some patients with suspected allergy to penicillin). 96 patients (41%) were initially treated with oral antibiotics (cotrimoxazole, aminopenicillin or co-amoxiclav). The initial antimicrobial regimen had to be modified in 31 cases (13%). In children with moderate to severe urinary tract infection prompt sterilization of urine and kidneys will prevent or suppress renal tissue lesions. The in vitro susceptibility results observed in the pathogens isolated in the patients prompt us to suggest that the above mentioned goal can only be achieved by an initial regimen consisting of an aminopenicillin and an aminoglycoside compound administered parenterally.