Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Abstract

The article reviews indications for and interpretation of urinalysis and urine culture results for diagnosis of UTI, choice of antibiotics for empiric and definitive UTI therapy, the rationale behind and indications for radiographic investigations, and prevention of UTIs including the complex decision as to whether antibiotic prophylaxis will benefit a child. Expert commentary: Over-diagnosis of UTI is a prevalent problem due to the lack of specificity of both urinalysis and urine culture. The most major recent advance in the field has been the recognition that antibiotic prophylaxis for UTI is rarely indicated as in most situations, the number needed to treat to prevent one UTI is too high to justify the risk of adverse events and development of antimicrobial resistance.

High rates of multidrug resistance among uropathogenic Escherichia coli in children and analyses of ESBL producers from Nepal

“…Worldwide, an estimated 8% of girls and 2% of boys experience at least one episode of UTI by the age of seven years and recurrence occurs in 12-30% of them within a year [2]. Pediatric UTI in many instances, remain under-diagnosed because of the absence of specific symptoms and signs, particularly in infants and young children [2, 3]. Therefore, accurate diagnosis and appropriate use of antimicrobials for treatment and prevention of urinary tract infections (UTIs) is vital to reduce the burden and also to prevent the possible long-term consequences [4].…”

“…Extended-spectrum β-lactamase (ESBL), a major beta lactamase enzyme, has the ability to hydrolyze oxyimino-cephalosporins, and monobactams but not cephamycins or carbapenems and inhibited in-vitro by inhibitors such as clavulanic acid, sulbactam and tazobactam [8]. Since their evolution in 1983, more than 300 types of ESBLs have been identified in various members of the family Enterobacteriaceae and other non-enteric organisms [3, 6]. The infections associated with these ESBL producing isolates are difficult to treat because of their resistance towards beta lactam agents and also due to the emergence of co-existing resistance determinants such as aminoglycosides and fluoroquinolones [7].…”

Antibacterial effect of green tea extract against multi drug resistant Escherichia coli isolated from urine sample of patients visiting tertiary care hospital of Eastern Nepal

“…UTI is the second most common infectious presentation in community practice caused by Uropathogenic Escherichia coli (UPEC), one of the members of the extra-intestinal pathogenic E. coli (ExPEC) (Zorc et al, 2005). These strains harbor a variety of virulence factors that allow them to establish an infection, including adhesins, toxins, host defense avoidance mechanisms and multiple ions acquisition systems (Robinson and Le, 2016).…”

Bacterial Aetiology and Antibiotic Resistance Pattern of Community-Acquired Urinary Tract Infections in Children in a Tertiary Care Hospital in Bangladesh

“…7 Community-acquired UTIs (CAUTI) are often treated with different broad-spectrum antibiotics, when one with a narrow spectrum of activity may be appropriate, because of concerns about infection with resistant organisms. 3,4 The extensive uses of antimicrobial agents have invariably resulted in the development of antibiotic resistance which, in recent years, has become a major problem worldwide. 8 In Bangladesh, paediatric UTIs are usually treated empirically because of the unavailability of standard therapeutic guidelines and local susceptibility data.…”

“…5,6 Paediatric UTIs remain underdiagnosed in many instances because of the absence of specific symptoms and signs, particularly in infants and young children. 2,4 Therefore, accurate diagnosis and appropriate use of antimicrobials for treatment and prevention of urinary tract infections (UTI) are vital to reduce the burden and also to prevent the possible long-term consequences. 7 Community-acquired UTIs (CAUTI) are often treated with different broad-spectrum antibiotics, when one with a narrow spectrum of activity may be appropriate, because of concerns about infection with resistant organisms.…”