Multidrug-resistant organisms in urinary tract infections in children

Mahony, Michelle; McMullan, Brendan; Brown, Jonathon D.; Kennedy, Seán

doi:10.1007/s00467-019-04316-5

Cited by 43 publications

(34 citation statements)

References 63 publications

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“…These findings may be associated with the significant rise of AMC resistance. Since resistance is generally mediated by a plasmid encoding resistance to several antimicrobials, this could explain our findings, as previously documented in ESBL-producing bacteria [ 22 ].…”

Section: Discussionsupporting

confidence: 77%

Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

et al. 2021

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Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.

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Section: Discussionsupporting

confidence: 77%

Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

et al. 2021

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“…The higher prevalence of MDR in Kathmandu than Bhaktapur may be due to bigger general hospitals in Kathmandu, where children and adults with more risk factors for MDR are treated, than in Bhaktapur. Previous antimicrobial use, previous hospitalisation, urinary catheterisation, and urinary tract anomalies are some of the known risk factors for MDR [19,20]. We found that MDR was significantly more prevalent in children younger than 5 years than older children.…”

Section: Discussionmentioning

confidence: 62%

Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal

et al. 2020

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Background: The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)producing uropathogens has complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly, may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children. Methods: During the study period (April 2017-April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI. Results: We processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12-53 months). Escherichia coli (n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin, nitrofurantoin, and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03). Conclusions: Nitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal. MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance.

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“…In Turkey, comparing the data collected in a single paediatric institution from 2009 to 2014, it was shown that E. coli resistance during the study period increased for ampicillin from 47.1% to 89%, for trimethoprim-sulphamethoxazole from 44.8% to 56% and for nitrofurantoin from 5.3% to 15.1% [8]. The most frequent risk factors associated with the development of UTIs due to antimicrobial-resistant pathogens are the previous use of antibiotics and urinary tract abnormalities [7][8][9][10]. Nevertheless, data for the surveillance of antibiotic resistance in UTIs frequently do not distinguish between adult and paediatric populations, and in many cases, the data are limited to single resistance mechanisms of specific pathogens, predominantly extended-spectrum beta-lactamase (ESBL)producing E. coli.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, data for the surveillance of antibiotic resistance in UTIs frequently do not distinguish between adult and paediatric populations, and in many cases, the data are limited to single resistance mechanisms of specific pathogens, predominantly extended-spectrum beta-lactamase (ESBL)producing E. coli. Furthermore, the prevalence of ESBL-producing pathogens in paediatric UTIs varies from 0.5% to 50% across studies [9][10][11]. In light of the variability in the data in the literature, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in paediatric UTIs in specific geographical areas to optimize therapeutic management.…”

Section: Introductionmentioning

confidence: 99%

Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy

Esposito

Maglietta²,

Costanzo

et al. 2021

Antibiotics

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The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between January 1st, 2012, and June 30th, 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.

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Multidrug-resistant organisms in urinary tract infections in children

Cited by 43 publications

References 63 publications

Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal

Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy

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