Trends in Distribution and Antibiotic Resistance of Bacteria Isolated from Urine Cultures of Children in Northern Israel Between 2010 and 2017

Abstract

Objectives: To identify the changing trends of uropathogens over the years 2010-2017 and examine the incidence of both antibiotic resistance and extended spectrum beta lactamases (ESBL)-producing Enterobacteriaceae in urine cultures from pediatric patients. Study Design: Electronic medical records of 1,056 children, admitted to the Poriya Medical Center in Israel, between 2010 and 2017 with positive urine cultures, were reviewed for bacterial species and antibiotics resistance. Results: The leading pathogen was Escherichia coli (76%), followed by Klebsiella (7%), Enterococcus (5.8%), and Proteus (4%). Statistically significant gender-specific and ethnicity-specific differences in the distribution of uropathogens were found. E. coli was more common in females compared to males. Escherichia coli constituted most (92.3%) of the ESBL-positive cultures, while only 4.6% isolates carried Klebsiella, 1.5% carried Enterobacter spp., and 1.5% carried Morganella. Prevalence of ESBL-producing E. coli increased throughout the study period. Increasing prevalence over time was noted for ceftriaxone, cefuroxime, amoxicillin/clavulanate, and ampicillin resistance. Conclusions: Gender and ethnic background should be taken into consideration when choosing empiric antibiotic therapy for urinary tract infections in children. Similarly, the continuous increase in resistance to cefuroxime and amoxicillin/clavulanate should be considered when prescribing therapy in Israel. Ceftriaxone and gentamicin are still the antibiotics of choice for inpatient parenteral empiric treatment.

Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia

“…The study revealed that ampicillin (95.5%) was the least effective drug followed by oxacillin (87.5%), penicillin (84.8%), co-trimoxazole (82.5%), erythromycin (74.2%), and nalidixic acid (60%) whereas the most effective antibiotics were imipenem (7.7%), nitrofurantoin (29.6%) and cefotaxime (34.1%). An increasing prevalence of uropathogen resistance to ceftriaxone, cefuroxime, amoxicillin/clavulanate, and ampicillin had been reported in children [32]. Therefore, prescribing amoxiclav, cotrimoxazole and nalidixic acid in children should be done cautiously with susceptibility testing.…”

Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia

“…The study revealed that ampicillin (95.5%) was the least effective drug followed by oxacillin (87.5%), penicillin (84.8%), co-trimoxazole (82.5%), erythromycin (74.2%), and nalidixic acid (60%) whereas the most effective antibiotics were imipenem (7.7%), nitrofurantoin (29.6%) and cefotaxime (34.1%). An increasing prevalence of uropathogen resistance to ceftriaxone, cefuroxime, amoxicillin/clavulanate, and ampicillin had been reported in children (30). Therefore, prescribing amoxiclav, cotrimoxazole and nalidixic acid in children should be done cautiously with susceptibility testing.…”

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

“…2,3 Considerations when choosing empirical antibiotic therapy must include local epidemiologic data on ANS rates, 4,5 as well as additional considerations, such as antibiotic side effects and administration of short treatment regimens whenever possible. 6 Guidelines for UTI management in children [7][8][9][10] all recommend that clinicians should base their choice of empiric treatment on local antimicrobial sensitivity patterns, and adjust the antibiotic treatment according to the sensitivity testing of the isolated uropathogens. This practice derives from the fact that initial treatment is almost always prescribed empirically, 4,11 and that adequate treatment in the first 72 hours can prevent complications such as hypertension, renal scarring and terminal renal disease.…”

“…Additionally, the usage of quinolones is a suggested antibiotic of last resort. 8,10 Rates of ANS in UTI vary considerably in different countries and different settings, 4,8,9,14 and high rates of extended-spectrum beta-lactamase (ESBL, excluding the possibility of cephalosporin treatment), 7 TMP/SMX and ciprofloxacin nonsusceptibility are reported in both Europe, the United States and Israel. [7][8][9][10] As a result, the treating physician is often left without a sufficiently valid oral antibiotic empiric treatment.…”

“…Guidelines for UTI management in children 7–10 all recommend that clinicians should base their choice of empiric treatment on local antimicrobial sensitivity patterns, and adjust the antibiotic treatment according to the sensitivity testing of the isolated uropathogens. This practice derives from the fact that initial treatment is almost always prescribed empirically, 4,11 and that adequate treatment in the first 72 hours can prevent complications such as hypertension, renal scarring and terminal renal disease.…”