Treatment of recurrent complicated urinary tract infections in children with vesicoureteral reflux

Abstract

Available online ---KEYWORDS children; drug susceptibility; fosfomycin; urinary tract infection; vesicoureteral reflux Background: Urinary tract infections (UTIs) in children with vesicoureteral reflux (VUR) are often caused by uropathogens with a high rate of drug resistance and are associated with a high rate of recurrence with a single pathogen. In this study, we evaluated the incidence of recurrent UTI and the drug resistance pattern of Escherichia coli in children with VUR. We also evaluated whether combination therapy comprising fosomycin plus one other antimicrobial agent is effective for treatment of recurrent UTIs. Methods: We retrospectively reviewed the medical records of all children with VUR who developed at least one episode of UTI during the period January 1, 2003 to December 31, 2013 at a single medical center. The effectiveness of fosfomycin plus amikicin for Enterobacteriaceae or ceftazidime for Pseudomonas aeruginosa infections was prospectively studied in six children with recurrent relapsing UTIs. Results: The study population comprised 129 children (age range, from 1month to 15 years; mean AE standard deviation, 2.37 AE 2.91 years) with VUR who developed at least one UTI during the 10-year study period; 68 (52.7%) had recurrent UTIs. The presence of an underlying urinary tract anomaly was predictive of recurrence (p Z 0.028). The rates of susceptibility of E. coli to Journal of Microbiology, Immunology and Infection (2014) xx, 1e6 cefazolin (p < 0.001) and cefotaxime (p < 0.001) were significantly lower in patients with recurrent UTIs. Combination therapy with fosfomycin plus amikacin or ceftazidime was shown to be an effective therapeutic option for recurrent UTIs due to a single uropathogen. Conclusion: The rates of susceptibility of E. coli to commonly used antimicrobials were significantly lower in children who developed more than one episode of UTI. The empiric choice of cefazolin or cefotaxime was usually ineffective. Administration of fosfomycin plus amikacin or ceftazidime was an effective therapeutic and preventive strategy in children with VUR and recurrent relapsing UTI.

Urinary Tract Infections among Bladder Outlet Obstruction Patients in Accra, Ghana: Aetiology, Antibiotic Resistance, and Risk Factors

“…In such cases, combination therapy would perhaps be ideal. A study showed that the combination of fosfomycin and amikacin or ceftazidime was an effective therapeutic and preventive strategy in children with vesicoureteral reflux and recurrent relapsing urinary tract infection [ 35 ]. Antibiotic treatment outcomes are adversely affected by the presence of risk factors such as catheterization and, therefore, urinary catheters should be replaced before initiating antimicrobial therapy [ 19 ].…”

Fosfomycin

“…In addition, a discordance between in vitro susceptibility to fosfomycin and microbiological effectiveness was observed in patients with P. aeruginosa (75% versus 38%) and CR K. pneumoniae UTIs (92% versus 46%) (230). Furthermore, in a small case series of kidney transplantation patients and children with vesicoureteral reflux disease, a high rate of recurrent infections was reported, mainly due to different or more susceptible bacteria than those for which fosfomycin was initially prescribed (231,232). More robust data from well-designed and adequately powered studies should become available in order to reach safer conclusions.…”

Targeted Workup after Initial Febrile Urinary Tract Infection: Using a Novel Machine Learning Model to Identify Children Most Likely to Benefit from Voiding Cystourethrogram

“…18,19 Similarly, previous antibiotics exposures and resistance were highly related with rUTI in VUR patients. 20,21 Unfortunately circumcision was too rare in our cohort to be incorporated into the model meaningfully. Hypertension was also a known sequela from reflux nephropathy and pyelonephritis, and was selected by the algorithm.…”