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[Antibiotic sensitivity to isolated bacteria in pediatric urinary tract infections]
1Service de microbiologie, hôpital d'enfants Armand-Trousseau, Paris, France.
Insights
Childhood urinary tract infections are often caused by E. coli and other bacteria. Antibiotic resistance varies, with high susceptibility to newer agents but concerning resistance to older ones like cotrimoxazole.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Context:
- Urinary tract infections (UTIs) are common in children.
- Identifying causative pathogens and their antibiotic susceptibility is crucial for effective treatment.
Purpose:
- To analyze the prevalence of common bacterial uropathogens in children.
- To determine the antibiotic resistance patterns of these key pathogens.
Summary:
- Escherichia coli is the most frequent cause of childhood UTIs, with significant ampicillin resistance but good susceptibility to amoxicillin/clavulanic acid and newer agents.
- Proteus mirabilis and Klebsiella species also show ampicillin resistance, with varying susceptibility to amoxicillin/clavulanic acid.
- While third-generation cephalosporins, aminoglycosides, and ciprofloxacin remain highly effective against these common uropathogens, resistance to cotrimoxazole is notable.
- Other enterobacteria exhibit widespread resistance to ampicillin and amoxicillin/clavulanic acid, with exceptions.
- Enterococci and Pseudomonas aeruginosa show increased resistance in hospital-acquired infections compared to community-acquired ones.
- Community-acquired Staphylococcus aureus remains susceptible to oxacillin, while coagulase-negative staphylococci from hospitalized patients display high resistance to oxacillin and other agents.
Impact:
- Provides essential data for guiding empirical antibiotic therapy in pediatric UTIs.
- Highlights the need for ongoing surveillance of antimicrobial resistance trends.
- Informs antibiotic stewardship programs to optimize treatment strategies and combat resistance.
Abstract:
Of the childhood urinary tract infections, more than 50% are caused by Escherichia coli (E Coli), followed by Proteus mirabilis (P mirabilis), Klebsiella sp, other enterobacteria, enterococci, Pseudomonas aeruginosa, and staphylococci. Of E coli isolates, 50 to 60% are resistant to ampicillin (ampi-R), 10% being susceptible to amoxicillin + clavulanic acid (AMC). For P mirabilis, ampi-R isolates are less frequent and more often susceptible to AMC. Klebsiella sp is resistant to ampicillin, 75% of isolates being susceptible to AMC. In these three species, the susceptibility of isolates to third generation cephalosporins, aminogly-cosides, and ciprofloxacin is still high (> 90%), but 15 to 35% are resistant to cotrimoxazole. In the other enterobacteria (Enterobacter cloacae, Morganella morganii, P vulgaris, Citrobacter freundii and Serratia marcescens) the resistance to cefalotin (hence to ampicillin and AMC) is permanent, with an exception: the susceptibility of P vulgaris to AMC. Enterococci are mostly susceptible to ampicillin, and P aeruginosa to ceftazidime, but in both species, the percentage of resistant strains in hospitalised patients is greater than in outpatients. For Staphylococcus aureus, the community-acquired isolates are susceptible to oxacillin and other anti-staphylococcal agents. All the coagulase negative staphylococci isolates are susceptible to vancomycin, but 70% of those from hospitalised patients are resistant to oxacillin, aminoglycosides and cotrimoxazole.