Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection

Abstract

Background: The most common oral antibiotics used in the treatment of urinary tract infection (UTI) are sulphonamides and cephalosporins, but emerging resistance is not unusual. Aims: To assess the change in susceptibility of urinary pathogens to oral antibiotics during the past decade in children with community acquired UTI. Methods: The study sample included two groups of children with a first community acquired UTI: 142 children enrolled in 1991 and 124 enrolled in 1999. UTI was diagnosed by properly collected urine specimen (suprapubic aspiration, transurethral catheterisation, or midstream specimen in circumcised males) in symptomatic patients. Antimicrobial susceptibility of the isolates was compared between the two groups. Results: The pathogens recovered in the two groups were similar: in 1991-E coli 86%, Klebsiella 6%, others 8%; in 1999-E coli 82%, Klebsiella 13%, and others 5%. A slight but generalised decrease in bacterial susceptibility to common antibiotics in the two groups was shown: ampicillin 35% versus 30%; cephalexin 82% versus 63% (p < 0.001); nitrofurantoin 93% versus 92%. The only exception was co-trimoxazole, 60% versus 69%. Overall resistance to antibiotics in 1999 was as follows: ampicillin 70%, cephalexin 37%, co-trimoxazole 31%, amoxicillin-clavulanate 24%, nitrofurantoin 8%, cefuroxime-axetil 5%, nalidixic acid 3%. Conclusions: This study shows a slight but generalised decrease in bacterial susceptibility to common oral antibiotics in the past decade in our population. Empirical initial treatment with co-trimoxazole or cephalexin is inadequate in approximately one third of UTI cases. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate (24% resistance); 95% of organisms are susceptible to cefuroxime-axetil.

Antibiotic sensitivity and resistance in children with urinary tract infection in Sanliurfa

“…Resistance rates against 3. generation cephalosporins were 6.8% in Isparta, 16.4% in Smyrna, 7.5% in Ankara, and 12.8% in Sivas. [6,20,21,24,26] In compliance with literature findings, ın our study resistance rates of E. coli against increasingly prevalent cefuroxime axetil, and ceftriaxone were found to be 38.1, and 39.5%, respectively. These higher rates of resistance suggest that 3. generation cephalosporins should not be preferred for the empirical treatment of UTI.…”

“…[13][14][15][16][17][18][19] Also in our country high rates of UTI with variations among regions have been reported. [20][21][22][23][24][25][26] Still, in our study as anticipated, gram-negative bacteria were the most frequently seen microbial agents, among this group mostly E. coli (64.5%) was isolated. E. coli was followed by Proteus spp.…”

“…Based on the reports of various studies, In a study reported from İzmir , rate of resistance of E.coli against ampicillin increased from 67 to 75% in İzmir, between the years 1999 to 2001, and from 57.1 to 79% between the years 1996 to 2006 in Isparta. [26,28] In the province of Sivas, E. coli was resistant to amoxicillin in 70.7% of the cases, respectively. [20] In our study the highest resistance was found against ampicillin-sulbactam (64.1%), followed by amoxicillin/clavulanate (57.1%).…”

“…As is the case in the whole world, enhanced resistance rates of E. coli against co-trimoxazole (43.6%) were detected in our study. [6,14,[18][19][20][21][22]26,[29][30][31][32][33] In studies performed hitherto, K. pneumonia has been isolated as a responsible uropathogen in 10% of the cases with UTI. [17][18][19][21][22][23][24][25][26]28,[32][33][34] In compliance with previous publications, antimicrobial resistance rate was detected as 12.1 percent.…”

“…[6,14,[18][19][20][21][22]26,[29][30][31][32][33] In studies performed hitherto, K. pneumonia has been isolated as a responsible uropathogen in 10% of the cases with UTI. [17][18][19][21][22][23][24][25][26]28,[32][33][34] In compliance with previous publications, antimicrobial resistance rate was detected as 12.1 percent. In a study reported from Tunisia, increased rates of antibiotic resistance of K. pneumonia were reported against amoxicillin/clavulanate, amoxicillin and cephalosporins in Tunisia, and and against nalidixic acid, and amoxicillin/clavulanate in Yemen.…”