High Rates of Antibiotic Nonsusceptibility in Gram-negative Urinary Tract Infection in Children With Risk Factors Occurring in the Preceding Month

Abstract

Background: Choosing an empiric treatment for urinary tract infections (UTIs) requires epidemiologic data on antibiotic nonsusceptibility (ANS) rates, and risk factors for UTI and ANS in the individual patient. We assessed ANS in community-acquired UTI, and its association with risk factors exposure (previous antibiotic treatment, UTI and hospital visit) <1 month or 1-11 months before the current UTI episode. Methods: This was a retrospective, cohort study. Children <2 years with hospital visits and a positive urine culture obtained <48 hours from hospital admission whose culture yielded Gram-negative bacteria during the years 2015-2016, were included. Results: Of the overall 744 episodes, 80% were Escherichia coli. Overall ANS rates were 66% for ampicillin; 27%-29% for amoxicillin/clavulanic acid, cephalosporins (indicating extended-spectrum beta-lactamase) and trimethoprim-sulfamethoxazole; 14% for nitrofurantoin; 5%-6% for gentamicin, ciprofloxacin and piperacillin/tazobactam; and <1% for meropenem and amikacin. Higher ANS rates were associated with Bedouin (vs. Jewish) ethnicity, exposure to risk factors <1 month, and to a lesser extent during the 1-11 months before the studied UTI episode. In episodes with risk factors <1 month, ANS rates were 81% for ampicillin; 47%-58% for amoxicillin/clavulanic acid, cephalosporins and trimethoprim-sulfamethoxazole; 19% for nitrofurantoin; 12%-23% for gentamicin, ciprofloxacin and piperacillin/tazobactam; and 2% for meropenem and amikacin. Conclusions: Previous antibiotic treatment, hospital admission and UTI, especially <1 month before the current episode, and Bedouin ethnicity, were all associated with high rates of ANS. These findings are important and may assist the treating physician in choosing an adequate empiric treatment for UTI.

Empiric Guideline Therapy for Simple Urinary Tract Infection at Outpatient Clinics: A Prospective Observational Study

“…These findings are important and may assist physicians in choosing an appropriate empiric treatment for UTI. 33 Our investigation clearly shows that there is a significant increase in trimethoprim and ciprofloxacin resistance among E. coli isolates taken from patients with UTI in our study area, which makes its empirical treatment challenging. The reported rates of resistance among the most frequent microorganisms in numerous research articles may vary depending on whether the study sample consists primarily of outpatients with uncomplicated UTI or patients with complicated infections.…”

Race, ethnicity, and risk for colonization and infection with key bacterial pathogens: a scoping review

“…36 Another study examined antibiotic susceptibility patterns among various pathogens ( K. pneumoniae , Enterobacter spp., and E. coli ) causing inpatient UTIs among children and reported a higher risk of resistance to some antibiotics (e.g., ampicillin, TMP/SMX, cephalosporins) among Bedouin versus Jewish children, but no significant difference for other antibiotics (e.g., nitrofurantoin, meropenem, amikacin). 39 Another study reported a higher risk of UTI caused by ESBL-producing vs non-ESBL-producing bacteria in Arab children than Jewish children. 52 In a prospective cohort study of 223 adults with UTIs caused by E. coli , P. aeruginosa , or Enterococcus faecium , no difference in antibiotic susceptibility patterns was observed between Bedouin versus non-Bedouins adults.…”

“…Among the 54 included studies, 3,12–69 42 (78%) described infections and 12 (22%) described colonization with at least one of the pathogens of interest ( Table 1 ). 13,18,26,33,37,43,45,47,50,51,53–55,57 Most studies were from the USA (n=42), 3,14–17,20,21,21,23–28,30–33,37,38,40–42,44–51,53–63,67–69 although studies from Israel (n=5), 13,29,34,36,39,52 New Zealand (n=4), 12,43,64–66 Australia (n=2), 19,35 and Brazil (n=1) 18 were also identified ( Figure 1 ). Studies of infection most often included patients with skin and soft tissue infection (SSTI) caused by S. aureus or urinary tract infection (UTI) caused by E. coli or other Enterobacterales, while other infections like community-acquired pneumonia (CAP) were described more rarely.…”

“…Bedouin persons were generally reported to have either a higher or similar risk of infection or colonization with the pathogens of interest, relative to Jewish persons in Israeli studies. 13,29,34,36,39,52 Two studies compared the ethnicity of children either colonized or infected with MRSA to those with either MSSA or no MRSA. 13,34 Both studies found that Arab or Bedouin children, who are the ethnic minority in Israel, were at a significantly higher risk of MRSA compared to Jewish children.…”

Clinical and epidemiological characteristics and frequent symptomatology of patients with urinary tract infections in a General Hospital in Paraguay during the year 2022

“…Sin embargo, otros microorganismos, como Staphylococcus saprophyticus, Klebsiella pneumoniae y Proteus mirabilis, también pueden estar involucrados. (5,6,7) Comprender qué patógenos están implicados y cómo interactúan con el tracto urinario es esencial para desarrollar estrategias de prevención y tratamiento adecuadas. (8) Esta información es fundamental para el desarrollo de medidas preventivas efectivas, la mejora de los protocolos de tratamiento y la reducción de la carga global de las infecciones urinarias en la población.…”