Antibiotic Resistance Patterns of Community-Acquired Urinary Tract Infections in Children With Vesicoureteral Reflux Receiving Prophylactic Antibiotic Therapy

Cheng, Chi-Hui; Tsai, Ming-Horng; Huang, Yhu Chering; Su, Lin; Tsau, Yong-Kwei; Lin, Chi Jen; Chiu, Cheng Hsun; Lin, Tzou Yien

doi:10.1542/peds.2007-2926

Cited by 108 publications

(74 citation statements)

References 21 publications

(24 reference statements)

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“…This information includes factors that have been shown to be associated with an increased risk of UTI by a resistant organism, such as the current use of prophylactic antibiotics, previous antibiotic therapy, hospitalization within the previous year, or genitourinary tract abnormality. 13,16,17,20,21 Our findings reveal that although broad-spectrum antibiotics were administered in a significant percentage of UTI antibiotic visits, this number did not increase over time. Furthermore, we observed no differences in antibiotic prescribing based on nonclinical factors such as physician specialty or insurance type.…”

Section: Summary Of Findingsmentioning

confidence: 65%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Urinary tract infections represent a significant source of exposure to antibiotics in the pediatric population and often physicians must select the antibiotic treatment empirically. No examination of ambulatory antibiotic prescribing patterns in the United States for children with urinary tract infections has been performed. WHAT THIS STUDY ADDS:Ambulatory care physicians commonly prescribe broad-spectrum antibiotics, especially third-generation cephalosporins, for the treatment of pediatric urinary tract infections. Given that narrower-spectrum alternatives are frequently appropriate options for the treatment of these infections, efforts are necessary to promote more judicious antibiotic prescribing for pediatric urinary tract infections.abstract OBJECTIVE: The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). METHODS:We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second-and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. RESULTS: Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broadspectrum antibiotics (P ϭ .67); however, third-generation cephalosporin use doubled from 12% to 25% (P ϭ .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6 -8.5]), and temperature Ն100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0 -8.6]) were independent predictors of broadspectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. CONCLUSIONS: Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives. To our knowledge, no previous study has examined ambulatory antibiotic prescribing patterns in the United States for children with UTIs. Studies in the adult literature have demonstrated an increase in the use of broad-spectrum antibiotics for UTIs, 4-6 raising concerns that unnecessar...

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Section: Summary Of Findingsmentioning

confidence: 65%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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“…Our study had 3 major findings: (1) urine tests are not performed in a substantial percentage of antibiotic-treated UTI episodes, (2) there was considerable variation in urine culture utilization among different groups of patients and physicians, and (3) factors that place a patient at increased risk for resistant UTI (history of previous UTI, recent antibiotic exposure, recent hospitalization, and presence of genitourinary anomaly) [10][11][12] were not strongly associated with urine culture use.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] Recent antibiotic exposure was classified as an antibiotic prescribed within 30 days before the UTI visit date. Recent hospitalization was defined as hospitalization within 30 days before UTI visit date.…”

Section: Definitions and Measurementsmentioning

confidence: 99%

Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT:The diagnosis of urinary tract infection (UTI) is confirmed by urine testing with urinalysis and culture. No study has characterized the use of urine testing in the setting of empirical antibiotic prescription for outpatient UTI in children.WHAT THIS STUDY ADDS: Urine tests are not performed in a substantial percentage of antibiotic-treated pediatric UTIs. Additional research is necessary to determine whether empirical antibiotic prescription for UTI in children without urine testing is safe and effective. abstract OBJECTIVE: To characterize urine test use in ambulatory, antibiotictreated pediatric urinary tract infection (UTI). METHODS:We studied children ,18 years who had an outpatient UTI and a temporally associated antibiotic prescription from 2002 through 2007 by using a large claims database, Innovus i3. We evaluated urine-testing trends and performed multivariable logistic regression to assess for factors associated with urine culture use. RESULTS:Of 40 603 treated UTI episodes in 28 678 children, urinalysis was performed in 76%, and urine culture in 57%; 32% of children ,2 years had no urinalysis or culture performed for an antibiotic-treated UTI episode. Urine culture use decreased during the study period from 60% to 54% (P , .001). We observed variation in urine culture use with age (,2 years: odds ratio [OR] 1.0, 95% confidence interval [CI] 0.9-1.1; 2-5 years: OR 1.3, 95% CI 1.2-1.4; 6-12 years: OR 1.3, 95% CI 1.2-1.4, compared with 13-17 years); gender (boys: OR 0.8, 95% CI 0.8-0.9); and specialty (pediatrics: OR 2.6, 95% CI 2.5-2.8; emergency medicine, OR 1.2, 95% CI 1.1-1.3; urology: OR 0.5, 95% CI 0.4-0.6, compared with family/internal medicine). Recent antibiotic exposure (OR 1.1, 95% CI 1.1-1.2) and empirical broad-spectrum prescription (OR 1.2, 95% CI 1.1-1.2) were associated with urine culture use, whereas previous UTI and urologic anomalies were not.CONCLUSIONS: Providers often do not obtain urine tests when prescribing antibiotics for outpatient pediatric UTI. Variation in urine culture use was observed based on age, gender, and physician specialty. Additional research is necessary to determine the implications of empirical antibiotic prescription for pediatric UTI without confirmatory urine testing. Pediatrics 2013;132:437-444

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“…In a study conducted in the United Kingdom, it was almost recommended that routine antibiotic prophylaxis should be stopped in children having UTI (5,22). The rate of resistance against ampicillin ranged between 64.9% and 88% in studies performed in Turkey and in the world (7,9,(23)(24)(25)(26)(27)(28)(29). When antibiotic resistance in all patients was reviewed in the present study, the resistance rates were determined as 71.9% for ampicillin, 47.0% for piperacillin, 45.1% for TMP-SMX, 24.2% for AMO/CL, and 22.1% for ceftriaxone.…”

Section: Graphic1 Gender Distribution Of Isolated Bacteria In the Urmentioning

confidence: 99%

“…It was determined in both hospitals that E. coli infection rate was decreased in patients receiving antibiotic prophylaxis when compared with that in those with a previous UTI (23). However, there were significant decreases in susceptibility of all 3 rd generation cephalosporins, ciprofloxacin, gentamicin, and amikacin in patients receiving cephalosporins prophylaxis and significant decreases were determined in susceptibility of gentamicin and ciprofloxac in in patients receiving TMP-SXT prophylaxis (23). In the study, initiation of prophylaxis caused neither E. coli nor other bacteria in later cultures.…”

Section: Graphic1 Gender Distribution Of Isolated Bacteria In the Urmentioning

confidence: 99%

Effect of Prophylactic Antibiotic Use in the Development of Antibiotic Resistance in Children with Recurrent Urinary Tract Infections

Karacı¹,

Karagöz²,

Örnek³

et al. 2017

Haseki

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Aim:Although prophylactic antibiotic treatment is still debatable, it is currently in use in recurrent urinary tract infections (UTIs). In the present study, we aimed to observe if prophylactic antibiotic use had any effect on the development of antibiotic resistance in patients with recurrent UTIs who we followed up in our clinic. Methods: The present study was performed on patients aged between one month and 16 years, who had recurrent UTIs, and were followed up by the Department of Pediatrics at Bülent Ecevit University Medical School. Patient files were retrospectively reviewed, and 50 patients who received antibiotic prophylaxis and 100 patients without prophylaxis were enrolled in the study. Urinary tests, subsequent urinary culture results, and antibiotic resistances were compared between the groups. Results: The mean age was 42.7±44.2 months. The most frequently cultured isolated bacterium was Escherichia coli (E. coli) (58.4%). No difference was determined in bacteria in cultures between prophylaxis receivers and non-receivers. Isolation rate of E. coli was higher in urinary cultures in females than in males (p<0.001). When antibiotic resistance of all urinary culture-isolated bacteria was compared between the two groups, there was no statistically significant difference. However, an increased resistance against amoxicillin/clavulanic acid, ceftriaxone, and piperacillin was determined in prophylaxis group in whom E. coli was grown. In this study, general antibiotic resistance was most frequently observed against ampicillin (71.9%). Conclusion:In the present study, we observed that prophylaxis did not contribute so much to resistance other than E. coli. We recommend not preferring antibiotics which have increased resistance in our institution especially in children receiving prophylaxis for empirical treatment. Keywords: Childhood, urinary tract infection, prophylaxis, antibiotic resistance Amaç: Tekrarlayan idrar yolu enfeksiyonlarında (İYE) antibiyotik proflaksisi günümüzde tartışmalı da olsa kullanılmaya devam edilmektedir. Biz bu çalışmada, kendi kliniğimizde takip ettiğimiz tekrarlayan İYE'de kullanılan profilaksinin antibiyotik direnç gelişimine etkisinin olup olmadığını gözlemlemeyi amaçladık. Yöntemler: Bu çalışma Bülent Ecevit Üniversitesi Tıp Fakültesi Pediatri Departmanı'nca takip edilen bir ay ile 16 yaş arası tekrarlayan idrar yolu enfeksiyonu olan hastalarda yapılmıştır. Hasta dosyaları retrospektif olarak taranarak antibiyotik proflaksisi alan 50 ve almayan 100 hasta çalışmaya dahil edildi. Hastaların idrar tetkikleri, sonraki kültürlerindeki üremeleri ve bunların antibiyotik dirençleri gruplar arasında karşılaştırıldı. Bulgular:Hastaların %43,3 erkek, %56,7 kızlardan oluşmaktaydı ve ortalama yaşları 42,7±44,2 ay (1 ay-16 yaş) idi. Tüm kültürlerde en sık üreyen bakteri %58,4 ile Escherichia Coli (E. coli) idi. Profilaksi alan ve almayan gruplar arasında kültürde üreyen bakterilerin dağılımı açısından bir fark saptanmadı. Kızlardaki idrar kültürlerinde E. coli görülme oranı erkeklerden daha...

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Antibiotic Resistance Patterns of Community-Acquired Urinary Tract Infections in Children With Vesicoureteral Reflux Receiving Prophylactic Antibiotic Therapy

Cited by 108 publications

References 21 publications

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Use of Urine Testing in Outpatients Treated for Urinary Tract Infection

Effect of Prophylactic Antibiotic Use in the Development of Antibiotic Resistance in Children with Recurrent Urinary Tract Infections

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