Urinary Tract Infections in Children: Clinical and Antibiotic Susceptibility Data from a Tertiary Care Hospital
Abstract
Aim: Urinary tract infections (UTIs) are among the most common bacterial infections in children.
Empirical antibiotic treatment is recommended until the antibiogram reports of urine culture are
available. It is essential to initiate local UTI agents and their antimicrobial susceptibility patterns in
specific geographical regions to choose the best empirical antibiotics. The current study aimed to
determine causative microorganisms and antibiotic resistance patterns in children diagnosed with UTI.
Material and Methods: The study was carried out retrospectively with 216 children diagnosed with
UTIs for the first time. The patients were categorized into two groups according to age (≤1 year and >1
year). Demographic data, presenting symptoms, imaging findings, and urine and culture analysis results
were collected and compared between these two groups.
Results: Cefazolin and nitrofurantoin use may be preferred in the empirical treatment of UTIs caused
by Escherichia coli and Enterococcus spp. Additionally, amoxicillin/clavulanate was recommended in
the empirical therapy of UTIs caused by Enterococcus spp., Klebsiella spp., and Proteus spp. The
trimethoprim-sulfamethoxazole and nitrofurantoin resistance of E. coli was found to be statistically
significantly higher in the ≤1 year group (p=0.03 and p=0.01, respectively), while the nitrofurantoin
resistance of Klebsiella was statistically significantly higher in the >1 year group (p=0.01). The gentamicin
resistance of Klebsiella spp. was statistically significantly higher in the ≤1 year group (p=0.03).
Conclusion: It is important to detect regional antibiotic resistance patterns to manage UTIs and minimize
related complications. Antibiotic susceptibility studies are necessary to reduce improper antibiotic use
and resistance rates of antibiotics.
References
- 1. Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020;395(10237):1659-1668.
- 2. Lu J, Liu X, Wei Y, Yu C, Zhao J, Wang L, Hu Y, Wei G, Wu S. Clinical and microbial etiology characteristics in pediatric urinary tract infection. Front Pediatr 2022;10:844797.
- 3. Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Tekgül S; European Association of Urology; European Society for Pediatric Urology. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015;67:546-558.
- 4. Schlager TA. Urinary tract infections in infants and children. Microbiol Spectr 2016;4(5).
- 5. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health 2017;37:273-279.
- 6. NICE. Urinary tract infection in children in under 16s: diagnosis, treatment, and long-term management. CG54. [Clinical guideline]. London: National Institute for Health and Care Excellence; 2007. Available from: https://www.nice.org.uk/ guidance/cg54 (Accessed 01.11.2022).
- 7. Gupta K. Addressing antibiotic resistance. Am J Med 2002;113 Suppl 1A:29S-34S.
- 8. European Committee for Antimicrobial Susceptibility Testing (EUCAST) of the European Society of Clinical Microbiology and Infectious Dieases (ESCMID). EUCAST Definitive Document E.Def 1.2, May 2000: Terminology relating to methods for the determination of susceptibility of bacteria to antimicrobial agents. Clin Microbiol Infect 2000;6(9):503-508.
- 9. Morello W, La Scola C, Alberici I, Montini G. Acute pyelonephritis in children. Pediatr Nephrol 2016;31:1253-1265.
- 10. Shrestha LB, Baral R, Poudel P, Khanal B. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC Pediatr 2019;19:36.
- 11. Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children [published correction appears in Pediatrics. 2022;150(4)]. Pediatrics 2021;147(2):e2020012138.
- 12. Gonzalez D, Anand S, Mendez MD. Labial Adhesions. 2022 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
- 13. Manekar AA, Janjala N, Sahoo SK, Tripathy BB, Mohanty MK. Phimosis - Are we on right track? Afr J Paediatr Surg 2022;19:199-202.
- 14. Stojanovic VD, Milosevic BO, Djapic MB, Bubalo JD. Idiopathic hypercalciuria associated with urinary tract infection in children. Pediatr Nephrol 2007;22:1291-1295.
- 15. Nacaroglu HT, Demircin G, Bülbül M, Erdogan O, Akyüz SG, Caltik A.The association between urinary tract infection and idiopathic hypercalciuria in children. Ren Fail 2013;35:327-332.
- 16. Kumar V, Singh RKN, Verma PK, Bhat NK, Shrivastava Y, Yhoshu E, Bhatia M, Chacham S. Clinico-microbiological profile and clinical predictor of urinary tract infection in children: A single-center study from Himalayan foothills. Cureus 2023;15:e33289.
- 17. Colceriu MC, Aldea PL, Răchișan AL, Clichici S, Sevastre- Berghian A, Mocan T. Vesicoureteral reflux and innate immune system: physiology, physiopathology, and clinical aspects. J Clin Med 2023;12:2380.
- 18. Fenta A, Dagnew M, Eshetie S, Belachew T. Bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among clinically suspected children attending at Felege-Hiwot comprehensive and specialized hospital, Northwest Ethiopia. A prospective study. BMC Infect Dis 2020;20:673.
- 19. Kurt-Şükür ED, Özçakar ZB, Doğan Ö, Öztürk M, Karaman M, Çakar N, Güriz H, Yalçınkaya F. The changing resistance patterns of bacterial uropathogens in children. Pediatr Int 2020;62:1058-1063.
- 20. Gökçe İ, Çiçek N, Güven S, Altuntaş Ü, Bıyıklı N, Yıldız N, Alpay H. Changes in bacterial resistance patterns of pediatric urinary tract infections and rationale for empirical antibiotic therapy. Balkan Med J 2017;34:432-435.
- 21. Mekonnen S, Tesfa T, Shume T, Tebeje F, Urgesa K, Weldegebreal F. Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. PLoS One 2023;18:e0283637.
- 22. Araújo MRB, Sant’Anna LO, Santos NNCD, Seabra LF, Santos LSD. Monitoring fluoroquinolone resistance among ESBLpositive and ESBL-negative Escherichia coli strains isolated from urinary tract infections: An alert for empirical treatment. Rev Soc Bras Med Trop 2023;56:e0513.
- 23. Matheu J, Aidara-Kane A & Andremont A 2017. The ESBL Tricycle AMR Surveillance Project: A Simple, one Health Approach to Global Surveillance. One Health. Available from: http://resistancecontrol.info/2017/the-esbl-tricycle-amrsurveillance- project-a-simple-one-health-approach-to-globalsurveillance/ (accessed 02.11.2022)
- 24. Dejonckheere Y, Desmet S, Knops N. A study of the 20-year evolution of antimicrobial resistance patterns of pediatric urinary tract infections in a single center. Eur J Pediatr 2022;181:3271- 3281.
- 25. Koçak M, Büyükkaragöz B, Çelebi Tayfur A, Çaltik A, Köksoy AY, Çizmeci Z, Günbey S. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int 2016;58:467-471.
- 26. Gupta K, Hooton TM, Naber K, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:103-120.
- 27. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Roberts KB. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.
Çocuklarda İdrar Yolu Enfeksiyonları: Üçüncü Basamak Bir Hastanenin Klinik ve Antibiyotik Duyarlılık Verileri
Abstract
Amaç: İdrar yolu enfeksiyonları (İYE), çocuklarda en sık görülen bakteriyel enfeksiyonlar arasındadır.
İdrar kültürü ve antibiyogram sonuçları çıkana kadar ampirik antibiyotik tedavisi önerilir. İYE tedavisi için
kullanılabilecek en uygun ampirik antibiyotik seçeneğini belirlemek için o bölgeye özgü İYE ajanlarını
ve bunların antimikrobiyal duyarlılıklarını belirlemek esastır. Bu çalışma, bölgemizde İYE tanısı alan
çocuklarda etken mikroorganizmaları ve antibiyotik direnç paternlerini belirlemeyi amaçladı.
Gereç ve Yöntemler: Çalışma, ilk kez İYE tanısı alan 216 çocuk ile retrospektif olarak gerçekleştirildi.
Hastalar yaşlarına göre (≤1 yaş ve >1 yaş) iki gruba ayrıldı. Bu iki grup arasında demografik veriler,
başvuru semptomları, görüntüleme bulguları, idrar ve kültür analiz sonuçları toplandı ve karşılaştırıldı
Bulgular: Escherichia coli ve Enterococcus türlerinin neden olduğu İYE'lerin ampirik tedavisinde sefazolin ve nitrofurantoin kullanımı tercih
edilebilir. Ayrıca, Enterococcus spp., Klebsiella spp. ve Proteus spp.'nin neden olduğu İYE'lerin ampirik tedavisinde amoksisilin/klavulanat
önerilmiştir. E. coli'nin trimetoprim-sülfametoksazol ve nitrofurantoin direnci ≤1 yaş grubunda istatistiksel olarak anlamlı yüksek bulunurken
(sırasıyla p=0,03 ve p=0,01), Klebsiella'nın nitrofurantoin direnci >1 yaş grubunda istatistiksel olarak anlamlı derecede yüksek saptandı
(p=0,01). Klebsiella türlerinin gentamisin direnci ≤1 yaş grubunda istatistiksel olarak anlamlı derecede yüksek bulundu (p=0,03).
Sonuç: İYE'lerin tedavisinde ve komplikasyonların önlenmesinde bölgesel antibiyotik direnç paternlerini saptamak önemlidir. Uygunsuz
antibiyotik kullanımını ve antibiyotik direnç oranlarını azaltmak için antibiyotik duyarlılık çalışmaları gereklidir
Keywords
References
- 1. Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020;395(10237):1659-1668.
- 2. Lu J, Liu X, Wei Y, Yu C, Zhao J, Wang L, Hu Y, Wei G, Wu S. Clinical and microbial etiology characteristics in pediatric urinary tract infection. Front Pediatr 2022;10:844797.
- 3. Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Tekgül S; European Association of Urology; European Society for Pediatric Urology. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015;67:546-558.
- 4. Schlager TA. Urinary tract infections in infants and children. Microbiol Spectr 2016;4(5).
- 5. Korbel L, Howell M, Spencer JD. The clinical diagnosis and management of urinary tract infections in children and adolescents. Paediatr Int Child Health 2017;37:273-279.
- 6. NICE. Urinary tract infection in children in under 16s: diagnosis, treatment, and long-term management. CG54. [Clinical guideline]. London: National Institute for Health and Care Excellence; 2007. Available from: https://www.nice.org.uk/ guidance/cg54 (Accessed 01.11.2022).
- 7. Gupta K. Addressing antibiotic resistance. Am J Med 2002;113 Suppl 1A:29S-34S.
- 8. European Committee for Antimicrobial Susceptibility Testing (EUCAST) of the European Society of Clinical Microbiology and Infectious Dieases (ESCMID). EUCAST Definitive Document E.Def 1.2, May 2000: Terminology relating to methods for the determination of susceptibility of bacteria to antimicrobial agents. Clin Microbiol Infect 2000;6(9):503-508.
- 9. Morello W, La Scola C, Alberici I, Montini G. Acute pyelonephritis in children. Pediatr Nephrol 2016;31:1253-1265.
- 10. Shrestha LB, Baral R, Poudel P, Khanal B. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC Pediatr 2019;19:36.
- 11. Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children [published correction appears in Pediatrics. 2022;150(4)]. Pediatrics 2021;147(2):e2020012138.
- 12. Gonzalez D, Anand S, Mendez MD. Labial Adhesions. 2022 Aug 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
- 13. Manekar AA, Janjala N, Sahoo SK, Tripathy BB, Mohanty MK. Phimosis - Are we on right track? Afr J Paediatr Surg 2022;19:199-202.
- 14. Stojanovic VD, Milosevic BO, Djapic MB, Bubalo JD. Idiopathic hypercalciuria associated with urinary tract infection in children. Pediatr Nephrol 2007;22:1291-1295.
- 15. Nacaroglu HT, Demircin G, Bülbül M, Erdogan O, Akyüz SG, Caltik A.The association between urinary tract infection and idiopathic hypercalciuria in children. Ren Fail 2013;35:327-332.
- 16. Kumar V, Singh RKN, Verma PK, Bhat NK, Shrivastava Y, Yhoshu E, Bhatia M, Chacham S. Clinico-microbiological profile and clinical predictor of urinary tract infection in children: A single-center study from Himalayan foothills. Cureus 2023;15:e33289.
- 17. Colceriu MC, Aldea PL, Răchișan AL, Clichici S, Sevastre- Berghian A, Mocan T. Vesicoureteral reflux and innate immune system: physiology, physiopathology, and clinical aspects. J Clin Med 2023;12:2380.
- 18. Fenta A, Dagnew M, Eshetie S, Belachew T. Bacterial profile, antibiotic susceptibility pattern and associated risk factors of urinary tract infection among clinically suspected children attending at Felege-Hiwot comprehensive and specialized hospital, Northwest Ethiopia. A prospective study. BMC Infect Dis 2020;20:673.
- 19. Kurt-Şükür ED, Özçakar ZB, Doğan Ö, Öztürk M, Karaman M, Çakar N, Güriz H, Yalçınkaya F. The changing resistance patterns of bacterial uropathogens in children. Pediatr Int 2020;62:1058-1063.
- 20. Gökçe İ, Çiçek N, Güven S, Altuntaş Ü, Bıyıklı N, Yıldız N, Alpay H. Changes in bacterial resistance patterns of pediatric urinary tract infections and rationale for empirical antibiotic therapy. Balkan Med J 2017;34:432-435.
- 21. Mekonnen S, Tesfa T, Shume T, Tebeje F, Urgesa K, Weldegebreal F. Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. PLoS One 2023;18:e0283637.
- 22. Araújo MRB, Sant’Anna LO, Santos NNCD, Seabra LF, Santos LSD. Monitoring fluoroquinolone resistance among ESBLpositive and ESBL-negative Escherichia coli strains isolated from urinary tract infections: An alert for empirical treatment. Rev Soc Bras Med Trop 2023;56:e0513.
- 23. Matheu J, Aidara-Kane A & Andremont A 2017. The ESBL Tricycle AMR Surveillance Project: A Simple, one Health Approach to Global Surveillance. One Health. Available from: http://resistancecontrol.info/2017/the-esbl-tricycle-amrsurveillance- project-a-simple-one-health-approach-to-globalsurveillance/ (accessed 02.11.2022)
- 24. Dejonckheere Y, Desmet S, Knops N. A study of the 20-year evolution of antimicrobial resistance patterns of pediatric urinary tract infections in a single center. Eur J Pediatr 2022;181:3271- 3281.
- 25. Koçak M, Büyükkaragöz B, Çelebi Tayfur A, Çaltik A, Köksoy AY, Çizmeci Z, Günbey S. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int 2016;58:467-471.
- 26. Gupta K, Hooton TM, Naber K, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:103-120.
- 27. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Roberts KB. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011;128:595-610.
Details
| Primary Language | English |
|---|---|
| Subjects | Nefroloji, Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 31, 2023 |
| Acceptance Date | July 3, 2023 |
| Published in Issue | Year 2023 Volume: 7 Issue: 2 |
