Antibiotic resistance patterns of pediatric community-acquired urinary infections

Abstract

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77%. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55% and 51%). The antibiotic resistance rates for E. coli were: nitrofurantoin (6%), nalidixic acid (14%), 1 st generation cephalosporin (13%), 3 rd generation cephalosporins (5%), aminoglycosides (2%), norfloxacin (9%) and ciprofloxacin (4%). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population. Key-Words: Urinary tract infection, pediatrics urinary tract infection, bacterial resistance, Escherichia coli.Urinary tract infection (UTI) is a common cause of fever and one of the most common community-acquired infections. In vitro resistance is a significant problem, not only in complicated UTIs, but also in community-acquired urinary infections. Escherichia coli is the most frequent etiological agent, accounting for 65%-90% of urinary infections [1][2][3][4]. Frequent use of wide-spectrum antibiotics may change the intestinal flora, and as a consequence, induce bacterial resistance [5,6].The American Academy of Pediatrics, the Royal College of Physicians of London and the National Guideline Clearinghouse recommend empirical and precocious treatment of UTI, based on the susceptibility standard to the antimicrobials that are habitually utilized, with the objective of reducing risks of pyelonephritic scarring [7]. There is a paucity of literature concerning antibiotic therapy for uncomplicated UTI in the developing world. Increasing rates of resistance among bacterial uropathogens has caused growing concern in both developed and developing countries [8]. We evaluated the frequency of uropathogens in a community of São Paulo, Brazil, and we examined the antimicrobial susceptibility of E. coli and other uropathogens. Additionally, we compared the antimicrobial susceptibility of E. coli between two periods. Material and Methods PatientsThe study population consisted of children younger than 17 years old, who had culture-proven UTI evaluated in the pediatrics department of Santa Casa Hospital, from August 2004 to December 2005 and August 1986 to December 1989. The exclusion criteria were previous hospitalization (<30 days), presence of catheters and vesicle continent derivation (Mitrofanoff procedure). Urine CultureEpisodes of UTI were identified by positive urine culture. Cultures were obtained from midstream-collected urine or transurethral bladder catheterization. Bacterial identification and determination of antimicrobial susceptibilit...

Multi Drug Resistant Pathogens Causing Urinary Tract Infections in Children at Kathmandu Model Hospital

“…The results showed a considerable increase in resistivity of gram negative isolates to amoxycillin (80.36%) which was supported by several studies 11,12,18 . Nitrofurantoin demonstrated better activity against gram negative (98.21% susceptible) as well as gram positive isolates (100.0% susceptible), in agreement with data published by others 17,18,19 . The high level susceptibility of uropathogens to nitrofurantoin may be the narrow spectrum of activity, narrow tissue distribution (low or undetectable serum concentration) and limited contact with bacteria outside the urinary tract 20 .…”

“…Cotrimoxazole was replaced by fl uroquinolones and cephalosporins because of high level of resistance to this drug but unfortunately after sometime resistance to these drugs was also detected and published. Our study also showed the similar fi ndings with 28.5-30.35% resistance to quinolones, 39.2-50.0% resistance to cephalosporins and 48.21% resistance to cotrimoxazole for gram negative isolates 17 . The results showed a considerable increase in resistivity of gram negative isolates to amoxycillin (80.36%) which was supported by several studies 11,12,18 .…”

Prevalence of Cotrimoxazole Resistance Uropathogenic Bacteria in Iran: A Systematic Review and Meta-Analysis

“…coli resistance to cotrimoxazole in most developing countries demonstrated similar results. For example, this resistance has been reported 68.1% in Senegal (46), 58% in Turkey (98), 53% in Lebanon (102), 55% in Brazil (103), and 60% in Mexico (104). E. coli in Bangladesh showed the lowest susceptibility (20 -27%) to cotrimoxazole (105).…”

Clinical, Etiology and Antibiotic Susceptibility Profiles of Community-Acquired Urinary Tract Infection in a Baghdad Hospital

“…Urinary tract infection ranks one of most common medical disease encountered in medical practice with significant morbidity and health costs, occurring from neonate to elderly [11,12].…”