Pediatric - specific Antimicrobial Resistance Patterns of Urinary Tract Infections: A Single - Centre Experience from Turkey

Abstract

Objectives: Antimicrobial resistance of the causative microorganisms of pediatric urinary tract infection (UTI) is a growing problem. The aim of this study is to determine the changing pattern of antibiotic susceptibility in UTIs in an outpatient setting.

Methods: We retrospectively reviewed the medical records of pediatric patients with UTI who were followed-up in our center between January-2014 and May-2015.

Results: One hundred and seventy-one patients (M/F= 53/118; mean age 56 ± 47.2 months) with UTI were enrolled in this study. A total of 231 urinary pathogens were isolated from UTI episodes. The most common causative agent was Escherichia coli (E. coli) (70.6%) followed by Klebsiella spp. (16.5%), Proteus spp. (6.5%). One point eight percent of E. coli isolates were resistant to amikacin, 17.8% to gentamicin, 60.7% to TMP-SMX, 66,9% to ampicillin, 52.1% to cefixime, 46% to ceftriaxone, 54.6% to cefuroxime and 4.9% to nitrofurantoin.

Conclusions: TMP-SMX and nitrofurantoin are poor empirical choices for pediatric patients due high resistance rates and gastrointestinal side effects, respectively. Second and third -generation cephalosporins (cefixime) may not be considered as appropriate empiric antibiotic alternatives anymore given their high resistance rates in the next few years. Physicians who work in the primary health care should be encouraged for the selection of more appropriate antibiotics.

Keywords

• Urinary tract infection,antimicrobial resistance

References

1. 1. Elder JS. Urologic disorders in infants and children.In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson textbook of pediatrics, 16th edn. WB Saunders, Philadelphia,pp 2000;1621–5.
2. 2. Yared A, Edwards KM. Reevaluating antibiotic therapy for urinary tract infections in children. Arch Pediatr Adolesc Med. 2005;159:992–3.
3. 3. Yen ZS, Davis MA, Chen SC, et al. A costeffectiveness analysis of treatment strategies for acute uncomplicated pyelonephritis
4. in women. Acad Emerg Med. 2003;10:309-14.
5. 4. Adjei O, Opoku C. Urinary tract infections in African infants. Int J Antimicrob Agents. 2004;24:32–4.
6. 5. Haller M, Brandis M, Berner R. Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy. Pediatr Nephrol 2004; 19:982–6.
7. 6. Ladhani S, GransdenW. Increasing antibiotic resistance among urinary tract isolates. Arch Dis Child. 2003;88:444–5.
8. 7. Copp HL, Shapiro DJ, Hersh AL. National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998–2007. Pediatrics. 2011;127:1027-33.

9. 8. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. Wayne, PA: NCCLS. Twelfth informational supplement. Approved Standard 2002; M100-S12.
10. 9. Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin ediatr. 2013; 25: 88-94.
11. 10. Davis A, Obi B, Ingram M. Investigating urinary tract infections in children. BMJ. 2013;30;346:e8654.
12. 11. Marcus N, Ashkenazi S,Samra Z, et al. Community acquired Pseudomonas aeruginosa urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and treatment. Infection. 2008;36:421–6
13. 12. Catal F, Bavbek N, Bayrak O, et al. Antimicrobial resistance patterns of urinary tract pathogens and rationale for empirical therapy in Turkish children for the years 2000-2006. Int Urol Nephrol. 2009;41:953-7.
14. 13. Swerkersson S, Jodal U, Åhrén C, et al. Urinary tract infection in small outpatient children: the influence of age and gender on resistance to oral antimicrobials. Eur J Pediatr. 2014;173:1075-81
15. 14. Vélez Echeverri C, Serna Higuita LM, Serrano AK, et al. Resistance profile for pathogens causing urinary tract infection in a pediatric population, and antibiotic treatment response at a university hospital,2010-2011. Colomb Med (Cali). 2014;30;45:39-44.
16. 15. Greenfield SP, Wan J. Vesicoureteral reflux: practical aspects of evaluation and management. Pediatr Nephrol. 1996;10:789-94.
17. 16. Hellerstein S. Urinary tract infectionsold and new concepts. Pediatr Clin North Am. 1995;42:1433-56.
18. 17. Mahyar A, Ayazi P, Mavadati S, et al. Are clinical, laboratory, and imaging markers suitable predictors of vesicoureteral reflux in
19. children with their first febrile urinary tract infection? Korean J Urol. 2014;55:536-41.
20. 18. Gupta K. Addressing antibiotic resistance. Am J Med. 2002;113:295-345.
21. 19. Bauza E, Cercenado E. Klebsiella and Enterobacter Antibiotic resistance and treatment implications. Semin Respis Infecti. 2002;17:215-30.
22. 20. Freedman AL. Urologic Diseases in America Project: Urologic Diseases in North America Project:trends in resource utilization for urinary tract infections in children. J Urol. 2005;173:949-54.
23. 21. Caracciolo A, Bettinelli A, Bonato C, et al. Antimicrobial resistance among Escherichia coli that cause childhood community acquired urinary tract infections in Northern Italy. Ital J Pediatr. 2011; 37:3.
24. 22. Savas L, Guvel S, Turunc T, et al. Comparison of the causative microorganisms and their antibiotic susceptibility between ommunity acquired and nosocomial urinary tract infections. Türk Üroloji Dergisi. 2003; 29: 95-100.
25. 23. Prais D, Straussberg R, Avitzur Y, et al. Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection. Arch Dis Child. 2003;88:215–8.
26. 24. Lutter SA, Currie ML, Mitz LB, et al. Antibiotic resistance patterns in children hospitalized for urinary tract infections. Arch Pediatr Adolesc Med. 2005;159:924–8.
27. 25. Jakovljević E, Ilić K, Jelesić Z, et al. A one year prospective study on the antibiotic resistance of E. coli strains isolated in urinary specimens of children hospitalized at the University Pediatric Medical Center in Novi Sad, Serbia. Infection. 2013;41:1111-9.
28. 26. Yüksel S, Oztürk B, Kavaz A, et al. Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections. Int J Antimicrob Agents. 2006;28:413-6.
29. 27. Abelson Storby K, Osterlund A, Kahlmeter G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12 year analysis. Acta Paediatr. 2004;93:487–91.
30. 28. Bean DC, Krahe D, Wareham DW. Antimicrobial resistance in community and nosocomial Escherichia coli urinary tract
31. isolates, London 2005 –2006. Annals of Clinical Microbiology and Antimicrobials. 2008;7:13.
32. 29. Kher KK, Leichter HE. Urinary tract infection. In: Kher KK,Makker SP, editors. Clinical pediatric nephrology. Singapore: McGraw-Hill Inc.1992;277–321.
33. 30. Karpman E, Kurzrock EA. Adverse reactions of nitrofurantoin,trimethoprim and sulfamethoxazole in children. J Urol. 2004;172:448–53.
34. 31. Bush K. Isit important to identify extended spectrum betalactamase producing isolates? Eur J Clin Microb Infect Dis.
35. 1996;15:361–4.
36. 32. Winstanley TG, Limb DI, Eggington R, Hancock F. A 10 year survey of the antimicrobial susceptibility of urinary tract isolates in the UK: the Microbe Base project. J Antimicrob Chemother. 1997;40:591–4.