Antibiotic resistance in pediatric urology

Edlin, Rachel S.; Copp, Hillary L.

doi:10.1177/1756287213511508

Cited by 30 publications

(18 citation statements)

References 54 publications

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“…The more antibiotics are used in a community, the more likely it is that resistant strains will be selected and maintained in the environment ( 8 , 15 , 26 ). This complements the current high rate of resistance following ampicillin, co-trimoxazole, gentamicin and ceftriaxone exposure within three months prior to the diagnosis of UTI in our hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, empirical antibiotic prescription is often endorsed even without culture and sensitivity. On the other hand, the emergence of antibiotic resistant uropathogens in pediatric urology is increasing worldwide; particularly in developing countries where empirical treatment is the mainstay of treatment in the absence of proper diagnostic modalities and the availability of antibiotics over the counter ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

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Pediatric urinary tract infection as a cause of outpatient clinic visits in southern Ethiopia: a cross sectional study

Mitiku¹,

Amsalu²,

Tadesse³

2018

Ethiop J Health Sci

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BackgroundFailure to timely diagnose and treat urinary tract infections is associated with grave long term consequences. The objectives of this study included assessing the proportion and predictors of Urinary Tract Infection (UTI) as a cause of pediatric outpatient department (OPD) visits and determining common uropathogens with antimicrobial susceptibility pattern.MethodsA cross sectional study was conducted from May to September 2015 among children of less than 15 years old at a tertiary center in Hawassa, Ethiopia. Children who fulfilled predefined eligibility criteria were recruited to undergo urine culture and urine analysis.ResultsA total of 863 children visited the OPD during the study period among which 269(31.2%) fulfilled the predefined eligibility criteria. Urine culture was positive for 74/269(27.5%) of the clinically suspected children. Male uncircumcision (adjusted odds ratio (aOR) 3.70; 95% CI 1.34–10.16) and under nutrition (aOR 5.41; 95%CI 2.64–11.07) were independent predictors of culture positivity. More than 5 WBC per high power field (aOR 4.7, 95% CI 1.8–12.7) on microscopy, urine PH > 5.0 (aOR 2.6, 95%CI 1.2–5.8), and positive leukocyte esterase (aOR 9.9, 95%CI 4.1–25.7) independently predicted positive growth on urine culture. Escherichia coli (34/74, 45.9%) and Klebsiella spp (18/74, 24.3%) were the most frequent isolates. High resistance was noted against amoxicillin (70.6%) and cotrimoxazole (97.1%) by E. coli.ConclusionUTI accounted for a tenth of total OPD visits. Commonly used first line antibiotics showed high level resistance to common etiologies of UTI. UTI should be suspected in febrile children, and antibiograms should be done to tailor prescription of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pediatric urinary tract infection as a cause of outpatient clinic visits in southern Ethiopia: a cross sectional study

Mitiku¹,

Amsalu²,

Tadesse³

2018

Ethiop J Health Sci

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“…Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey suggest that 32% of children with UTI are treated with a broad-spectrum antibiotics, despite the fact that national UTI resistance patterns demonstrate that most uropathogens are sensitive to narrow-spectrum alternatives, with consistently low resistance rates [9]. Importantly, ineffective empiric antibiotic therapy may contribute to increased morbidity and increased costs due to prolonged antibiotic treatment, recurrent office or emergency room visits, and hospital admissions [10,11]. The Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases recommend that antibiotics should not be used empirically if local resistance rates of uropathogens exceed >20% [12].…”

Section: Discussionmentioning

confidence: 99%

Determinants of practice patterns in pediatric UTI management

Selekman

Allen

Copp

2016

Journal of Pediatric Urology

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Summary Introduction Urinary tract infection (UTI) affects 10% of girls and 3% of boys by age 16. Both the American Academy of Pediatrics and National Institute for Health and Clinical Excellence Guidelines recommend urine testing prior to initiation of antibiotic treatment, and the use of local antibiograms to guide empiric antibiotic therapy. Urine culture results not only provide the opportunity to halt empiric therapy if there is no bacterial growth, but also allow for tailoring of broad-spectrum therapy. Additionally, the use of antiobiograms is recommended to improve empiric antibiotic selection based on local resistance patterns. However, execution of guideline recommendations has proven challenging. In order to develop targeted interventions aimed at improving adherence to these guidelines, understanding the barriers that may exist in implementing them is critical. Objectives The present study sought to investigate practice patterns and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of UTI in children, with the aim of ultimately improvinguo A adherence to UTI management guidelines. Study design A random, national sample of physicians caring for children was surveyed from the American Medical Association Masterfile. Participants were queried regarding practice type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. Results Of respondents who acknowledged contact by surveyors, 47% completed the survey (n=366). Most respondents (84%) obtained urinalysis and culture prior to treatment for UTI. Physicians reported that they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%). Urine collection by bag was more common in circumcised boys (>30%) compared with girls (20%) and uncircumcised boys (20%) (P=0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization. Of the 70% of respondents reporting antibiogram access (n=256), 50% reported its use the majority of the time with empiric prescription (n=128). Discussion While most practitioners reported following guidelines to obtain urine testing prior to antibiotic prescription for UTI, urine collection by bag was common. Additionally, <50% of practitioners adhered to guideline recommendations for empiric antibiotic selection based on local antibiograms. Interventions to improve adherence to UTI management guidelines should focus on: (1) improving catheterization practices; (2) educating parents regarding the value of catheterization; and (3) incorporating local antibiograms into electronic medical records.

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“…Treatment is geared toward relief of symptoms through killing the offending bacterial pathogen with antibiotics. Management centers on long-established principles of antibiotic use, including confirming the presence of infection with urine analysis followed by culture and sensitivity testing and administering empiric antibiotics for common uropathogens based on local antibiograms, or previous positive urine cultures if present, and a culture-specific antibiotic once antibiotic sensitivity is available 25 .…”

Section: Antibiotic Choice For Breakthrough Utimentioning

confidence: 99%

Urinary tract infection in the setting of vesicoureteral reflux

Garcia-Roig

Kirsch

2016

F1000Res

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Vesicoureteral reflux (VUR) is the most common underlying etiology responsible for febrile urinary tract infections (UTIs) or pyelonephritis in children. Along with the morbidity of pyelonephritis, long-term sequelae of recurrent renal infections include renal scarring, proteinuria, and hypertension. Treatment is directed toward the prevention of recurrent infection through use of continuous antibiotic prophylaxis during a period of observation for spontaneous resolution or by surgical correction. In children, bowel and bladder dysfunction (BBD) plays a significant role in the occurrence of UTI and the rate of VUR resolution. Effective treatment of BBD leads to higher rates of spontaneous resolution and decreased risk of UTI.

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Antibiotic resistance in pediatric urology

Cited by 30 publications

References 54 publications

Pediatric urinary tract infection as a cause of outpatient clinic visits in southern Ethiopia: a cross sectional study

Pediatric urinary tract infection as a cause of outpatient clinic visits in southern Ethiopia: a cross sectional study

Determinants of practice patterns in pediatric UTI management

Urinary tract infection in the setting of vesicoureteral reflux

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