1
|
Ehrlich S, Livni G, Zioni I, Barnea Melamed S, Pasternak Y. Prevalence of Enterococcal Urinary Tract Infections With Positive Nitrites in Urinalysis in Pediatric Patients With High-Risk for Enterococcal Infections. Clin Pediatr (Phila) 2024; 63:488-493. [PMID: 37326168 DOI: 10.1177/00099228231179937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Enterococcus is a relatively uncommon pathogen that causes urinary tract infections (UTIs) in healthy children. Most enterococcal infections occur in patients with risk factors such as anatomical or functional urinary tract anomalies, also known as CAKUT (congenital anomalies of kidney and urinary tract). Children who are suspected of having UTIs and who have certain risk factors are often treated specifically for enterococcal infection as part of their empiric regimen. Our primary objective was to determine the prevalence of enterococcal UTIs among high-risk children, and specifically among those with positive nitrite tests, with the goal of avoiding treatment with specific anti-enterococcal agents. This retrospective study included all the episodes of UTI treated at a tertiary pediatric center during 2010 to 2018. The data collected from medical records included nephrological and urological risk factors, nitrite status, and isolated pathogens. Of 931 episodes of UTI, 467 (50%) were considered high-risk. In all, 24 of the latter had Enterococcus as a single pathogen; 23 (96%) of these occurred in patients with negative nitrites in the first urine dipstick taken. The sole patient with high-risk factors, a positive nitrite test and coexisting enterococcal UTI had a history of previous enterococcal UTIs. In pediatric patients with nephrological and urological risk factors, who have positive nitrites in urinalysis, the risk for enterococcal UTI appears substantially low. Therefore, in this context, specific anti-enterococcal empirical antibiotic therapy may be unnecessary.
Collapse
Affiliation(s)
- Shay Ehrlich
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gilat Livni
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Tel Aviv University, Israel, Sackler Faculty of Medicine
| | - Inbar Zioni
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | - Yehonatan Pasternak
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Tel Aviv University, Israel, Sackler Faculty of Medicine
| |
Collapse
|
2
|
Kraszewska Z, Skowron K, Kwiecińska-Piróg J, Grudlewska-Buda K, Przekwas J, Wiktorczyk-Kapischke N, Wałecka-Zacharska E, Gospodarek-Komkowska E. Antibiotic Resistance of Enterococcus spp. Isolated from the Urine of Patients Hospitalized in the University Hospital in North-Central Poland, 2016-2021. Antibiotics (Basel) 2022; 11:antibiotics11121749. [PMID: 36551406 PMCID: PMC9774570 DOI: 10.3390/antibiotics11121749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Urinary Tract Infections (UTIs) are common outpatient and inpatient infections, often treated with empirical therapy. Enterococcus spp. is responsible for about 10% of UTIs. This study aimed to determine the necessity of changing the empirical treatment of UTIs caused by Enterococcus spp. The evaluation was performed for 542 Enterococcus strains isolated from urine samples in the years 2016-2021. We identified three Enterococcus species that were found: E. faecalis (389, 71.8%), E. faecium (151, 27.8%) and E. gallinarum (2, 0.4%). E. faecalis was the dominant species every year. Among E. faecalis, the most prevalent was resistance to norfloxacin (51.4%). Almost all E. faecium strains (150, 99.3%) were resistant to beta-lactams and norfloxacin. Eighty-three strains (55.0%) were resistant to vancomycin and 72 (47.7%) to teicoplanin. E. faecium strains showed a significantly higher percentage of resistance mechanisms GRE (Glicopeptide-Resistant Enterococcus) (72, 48.7%) and VRE (Vancomycin-Resistant Enterococcus) (11, 7.3%), while only five strains of E. feacalis showed a VRE mechanism (1.3%). In the therapy of E. faecalis UTIs, ampicillin and imipenem still remain effective. However, the above-mentioned antibiotics, as well as fluoroquinolones, are not recommended in the treatment of UTIs of E. faecium etiology.
Collapse
Affiliation(s)
- Zuzanna Kraszewska
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Krzysztof Skowron
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-512-210-245
| | - Joanna Kwiecińska-Piróg
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Katarzyna Grudlewska-Buda
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Jana Przekwas
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Natalia Wiktorczyk-Kapischke
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| | - Ewa Wałecka-Zacharska
- Department of Food Hygiene and Consumer Health, Wrocław University of Environmental and Life Sciences, 50-375 Wrocław, Poland
| | - Eugenia Gospodarek-Komkowska
- Department of Microbiology, Nicolaus Copernicus University in Toruń, L. Rydygier Collegium Medicum in Bydgoszcz, 9 M. Skłodowska-Curie St., 85-094 Bydgoszcz, Poland
| |
Collapse
|
3
|
Antibiogram of Urinary Tract Infections and Sepsis among Infants in Neonatal Intensive Care Unit. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050629. [PMID: 35626805 PMCID: PMC9139765 DOI: 10.3390/children9050629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 01/20/2023]
Abstract
Neonatal infections including sepsis and urinary tract infections are considered among the leading causes of mortality in neonatal intensive care units (NICU). Thus, use of empiric antibiotics is very important in infected neonates and the success of this practice is mainly reliant on the availability of an up-to-date antibiogram for currently used antibiotic drugs. In this study, we aim to determine the bacteriological profile and antibiotic susceptibility pattern of bacteria isolated from blood or/and urine cultures belonging to patients at the NICU. A total of 54 urine samples were collected in the period between January 2015 and December 2019. Data of infants with positive urine and blood bacterial isolates were gathered retrospectively. The most commonly isolated bacteria from urine observed were K. pneumoniae (44%) and E. coli (39%), while Acinetobacter baumannii (33%) and K. pneumoniae (22%) predominated in neonatal blood samples. The majority of uropathogens and blood isolates exhibited low resistance to imipenem and tigecycline, respectively. These antibiotics would be recommended for future use as empirical treatment in neonates with urinary tract infections and/or sepsis. This investigation highlights the importance of surveillance studies to manage and ensure the effectiveness of treatment plan for critically ill infants.
Collapse
|
4
|
Lepold AM, Tesfamichael DH, Hartmann FA, Wiley CA, Wood MW. Comparison of urine fibrinogen and interleukin-6 concentrations between healthy dogs and dogs with risk factors for enterococcal bacteriuria. Am J Vet Res 2021; 82:846-852. [PMID: 34554867 DOI: 10.2460/ajvr.82.10.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare urine concentrations of fibrinogen (uFIB) and interleukin-6 (uIL-6) between dogs with risk factors for enterococcal bacteriuria and healthy dogs. SAMPLE Banked urine samples with negative aerobic culture results from 8 dogs with urolithiasis, 9 dogs with anatomic abnormalities of the lower portion of the urinary tract (LUT), 10 dogs with LUT neoplasia, and 21 healthy control dogs. PROCEDURES Urine creatinine concentration (uCrea) was determined by an automated biochemical analyzer, and uFIB and uIL-6 were determined by dog-specific ELISAs. The uFIB:uCrea and uIL-6:uCrea ratios were calculated for each sample to normalize intersample differences in urine concentration and were compared among the 4 experimental groups. RESULTS Median uFIB:uCrea ratios for dogs with urolithiasis (0.72; interquartile [25th to 75 percentile] range [IQR], 0.46 to 3.48) and LUT neoplasia (6.16; IQR, 3.89 to 12.75), but not for dogs with LUT anatomic abnormalities (0.48; IQR, 0.27 to 0.69), were significantly greater than that for control dogs (0.17; IQR, 0.07 to 0.39). Median uIL-6: uCrea ratios for dogs with urolithiasis (0.48; IQR, 0.18 to 1.61), LUT anatomic abnormalities (0.25; IQR, 0.17 to 0.33), and LUT neoplasia (0.25; IQR, 0.12 to 1.01) were significantly greater than that for control dogs (0.08; IQR, 0.06 to 0.11). CONCLUSIONS AND CLINICAL RELEVANCE The uFIB and uIL-6 in dogs with risk factors for enterococcal bacteriuria were generally greater than corresponding values in control dogs. Further investigation is necessary to determine the role of fibrinogen in enterococcal colonization of the urinary tract of dogs.
Collapse
|
5
|
Clinical characteristics and prediction analysis of pediatric urinary tract infections caused by gram-positive bacteria. Sci Rep 2021; 11:11010. [PMID: 34040098 PMCID: PMC8155007 DOI: 10.1038/s41598-021-90535-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
Gram-positive (GP) pathogens are less accounted for in pediatric urinary tract infection (UTI), and their clinical impact is underrecognized. This study aimed to identify predictors of GP uropathogens in pediatric UTI. In this 14-year retrospective cohort of pediatric patients with UTI, we classified first-time UTIs cases into those caused by GP or Gram-negative (GN) bacteria. We constructed a multivariable logistic regression model to predict GP UTI. We evaluated model performance through calibration and discrimination plots. We developed a nomogram to predict GP UTI that is clinically feasible. Of 3783 children with first-time UTI, 166 (4.4%) were infected by GP and 3617 (95.6%) by GN bacteria. Among children with GP UTI, the most common uropathogens were vancomycin-resistant Enterococcus faecalis (VRE) (27.1%), Staphylococcus saprophyticus (26.5%), and coagulase-negative Staphylococci (12.7%). Eight independent risk factors were associated with GP UTI: Age ≥ 24 months (odds ratio [OR]: 3.21), no prior antibiotic use (OR: 3.13), serum white blood cell (WBC) count < 14.4 × 103/μL (OR: 2.19), high sensitivity C-reactive protein (hsCRP) < 3.4 mg/dL (OR: 2.18), hemoglobin ≥ 11.3 g/dL (OR: 1.90), negative urine leukocyte esterase (OR: 3.19), negative urine nitrite (OR: 4.13), and urine WBC < 420/μL (OR: 2.37). The model exhibited good discrimination (C-statistic 0.879; 95% CI 0.845–0.913) and calibration performance. VR E. faecalis, the leading GP uropathogen causing pediatric UTI, requires early detection for infection control. Our model for predicting GP UTI can help clinicians detect GP uropathogens and administer antibiotic regimen early.
Collapse
|
6
|
Song JY, Yoo S, Lim TJ, Byun JH, Jo KJ, Kim HY, Park SE, Kim SH. Ampicillin-sulbactam monotherapy in infants with febrile urinary tract infections. Pediatr Int 2021; 63:430-435. [PMID: 32885532 DOI: 10.1111/ped.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cephalosporin is the most commonly used empirical agent for urinary tract infections (UTIs) in children. However, increasing use of cephalosporins can lead to an increase in resistant pathogens. This study therefore aims to investigate the effects of monotherapy with ampicillin-sulbactam as an alternative to cephalosporins. METHODS All 2- to 24-month-old patients who were hospitalized at Pusan National University Children's Hospital due to a first episode of a febrile UTI during the 2-year period from 2012 to 2014 were included in the study. The subjects were divided into two groups according to their empirical therapy (cefotaxime or ampicillin-sulbactam). We determined the patients' UTI pathogens and their antibiotic susceptibilities and compared the effectiveness and the occurrence of adverse effects of ampicillin-sulbactam and cephalosporin therapy. RESULTS Forty-six patients were treated with cefotaxime (group A) and 41 patients with ampicillin-sulbactam as the empirical antibiotic (group B). The most common pathogen in both groups was Escherichia coli, and antibiotic susceptibilities of the bacterial strains isolated from both groups were similar in ampicillin-sulbactam and cefotaxime. In addition, there was no significant difference in the duration of fever after treatment between the two groups (group A: 2.0 versus group B: 3.0, P = 0.331). There were no treatment failures and no recurrence in either group, even in patients with resistant pathogens. The most common side effect of the antibiotic agents was diarrhea. CONCLUSIONS Ampicillin-sulbactam could be an effective alternative to cephalosporin as empiric antibiotic for the treatment of first-episode UTI in patients under 24 months of age.
Collapse
Affiliation(s)
- Ji Yeon Song
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Sukdong Yoo
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Taek Jin Lim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Joung-Hee Byun
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Kyo Jin Jo
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea
| |
Collapse
|
7
|
Das A, Banerjee T, Anupurba S. Susceptibility of Nitrofurantoin and Fosfomycin Against Outpatient Urinary Isolates of Multidrug-Resistant Enterococci over a Period of 10 Years from India. Microb Drug Resist 2019; 26:1509-1515. [PMID: 31794690 DOI: 10.1089/mdr.2019.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the increasing emergence of drug resistance in enterococci, there have been very limited data on the efficacy of orally available nitrofurantoin and fosfomycin on enterococci causing urinary tract infections (UTIs), particularly for multidrug-resistant (MDR) strains. This study aimed to determine the in vitro effectiveness of these two drugs against the MDR enterococci. A total of 514 phenotypically and genotypically confirmed isolates of enterococci (239, 46.5% Enterococcus faecalis and 275, 53.5% Enterococcus faecium) showed E. faecalis as significantly more resistant (p < 0.05) to ciprofloxacin and high strength gentamicin. Vancomycin resistance was seen in 37 (7.2%) isolates. Of these, 114 (22.18%) isolates (51, 44.73% E. faecalis and 63, 55.26% E. faecium) were MDR. Nitrofurantoin minimum inhibitory concentrations (MICs) for the MDR enterococci varied from 1 to 128 μg/mL (MIC50 8 μg/mL, MIC90 64 μg/mL for E. faecalis), while fosfomycin MICs for the MDR E. faecalis, including vancomycin resistant enterococci (VRE) were in susceptible range (≤64 μg/mL, MIC50 8 μg/mL, MIC90 16 μg/mL). An efficacy ratio of ≥8 for nitrofurantoin was observed in the 39 (76.5%) MDR E. faecalis and 44 (69.8%) MDR E. faecium isolates as against the 50 (98%) E. faecalis isolates for fosfomycin. Although nitrofurantoin has been widely prescribed for the treatment of UTIs for the past several years, it was still found to be active in vitro against the urinary isolates of MDR enterococci, including VRE. As for fosfomycin, it holds robust potential to be used against the urinary MDR enterococci and VRE (E. faecalis).
Collapse
Affiliation(s)
- Arghya Das
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shampa Anupurba
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
8
|
Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4909452. [PMID: 28497052 PMCID: PMC5405357 DOI: 10.1155/2017/4909452] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/30/2017] [Indexed: 12/02/2022]
Abstract
Background. The objective of this study was to identify the bacteria most frequently responsible for urinary tract infection (UTI) in the population of under-2-year-olds in our geographic area and to evaluate the activity of antibiotics widely used for UTI treatment during a 4-year study period. Materials and Methods. A retrospective analysis was conducted of data on the identification and susceptibility of microorganisms isolated in urine samples from children under 2 years of age. Results. A total of 1,045 uropathogens were isolated. Escherichia coli accounted for the majority (60.3%) of these, followed by Enterococcus faecalis (22.4%) and Klebsiella spp. (6.5%). The highest E. coli susceptibility rates (>90%) were to piperacillin-tazobactam, cefuroxime, cefotaxime, ceftazidime, imipenem, gentamicin, nitrofurantoin, and fosfomycin, and the lowest were to amoxicillin-clavulanic acid and cotrimoxazole. Among all bacteria isolated, we highlight the overall high activity of piperacillin-tazobactam, imipenem, nitrofurantoin, and fosfomycin against both community and hospital isolates and the reduced activity of amoxicillin-clavulanic acid, cephalosporins, gentamicin, and cotrimoxazole. There was no significant change in the total activity of any of the studied antibiotics over the 4-year study period. Conclusion. Empiric treatment with amoxicillin-clavulanic acid, cotrimoxazole, cephalosporins, and gentamicin may be inadequate due to their limited activity against uropathogens in our setting.
Collapse
|
9
|
Nyandwi J, Manirakiza S, Ndirahisha E, Ngomirakiza JB, Nisubire D, Nduwayo E, Bukuru H. Frequency of Uropathogens and Antimicrobial Susceptibility in Childhood Urinary Tract Infection at Kamenge University Hospital, Bujumbura, Burundi. East Afr Health Res J 2017; 1:47-52. [PMID: 34308158 PMCID: PMC8279265 DOI: 10.24248/eahrj-d-16-00331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/05/2017] [Indexed: 11/20/2022] Open
Abstract
Background Increasing resistance to antimicrobials is a worldwide problem. The aim of our study was to determine the pathogens and antimicrobial susceptibility of bacteria causing urinary tract infection (UTI) in children. Methods This is a prospective cohort study conducted over a 10-month period with 101 children hospitalised at Kamenge University Hospital for acute UTI. The infections were confirmed by Kass urinalysis criteria, and culture and susceptibility antibiotic tests were performed for isolated microbial agents. Results Frequency of UTI in the overall population of children hospitalised at Kamange University Hospital was 8.4%. Of the 101 children with UTIs, 87 (86.1%) were under the age of 24 months. Diagnosis of pyelonephritis (82%) was the most common, followed by cystitis (18%). Escherichia coli (82%) was the most frequent pathogen causing UTI. We found E coli and Klebsiella pneumonia to be resistant to aminopenicillins (100%), cotrimoxazole (98.2%, 100%), Augmentin (amoxicillin/clavulanic acid) (70.5%, 80%), cefotaxime (45.8%, 28.6%), cefuroxime (36.8 to 45.5%, 50%), fluoroquinolones (33.3 to 53.6%, 28.6 to 50%), gentamicin (27.5%, 20%), and nitrofurantoin (9.3%, 50%). Conclusion E coli is the main causal agent of UTI in childhood with a high resistance to antibiotics. Appropriate antibiotics for empiric therapy should be based on local circulating bacterial strains and resistance profiles.
Collapse
Affiliation(s)
- Joseph Nyandwi
- Département de Médecine Interne, Le Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi.,Unité d'Hémodialyse, Burundi Kidney Care Clinic, Bujumbura, Burundi
| | - Sébastien Manirakiza
- Département d'Imagerie Médicale, Le Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi
| | - Eugàne Ndirahisha
- Département de Médecine Interne, Le Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi
| | | | - Désiré Nisubire
- Département des Laboratoires, Le Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi
| | - Emmanuel Nduwayo
- Département de Médecine Interne, Le Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi
| | - Hélàne Bukuru
- Département de Pédiatrie, Le Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi
| |
Collapse
|
10
|
Abstract
BACKGROUND Few data exist on the presentations and clinical courses of infants with enterococcal urinary tract infections (UTI). The objective of this study was to compare the clinical presentation, sensitivity of urinalysis (UA) and Gram's stain, radiological abnormalities and adverse events of febrile infants with enterococcal UTIs to those with Gram-negative UTIs. METHODS Retrospective study of febrile (≥38.0°C) infants 29-60 days of age with UTIs at 20 emergency departments. UTI was defined as growth of (1) ≥50,000 colony forming units (CFUs)/mL of a single pathogen; or (2) either 10,000 to <50,000 CFUs/mL or 10,000-100,000 CFUs/mL (depending on laboratory reporting) with a positive UA or Gram's stain. RESULTS Thirty-seven (2.0%) of 1870 infants with febrile UTIs had enterococcal UTIs. On bivariable analysis, infants with enterococcal UTIs more frequently had histories of prematurity, previous hospitalizations, histories of genitourinary abnormalities, previous UTIs and ill-appearance in the emergency department compared with infants with Gram-negative UTIs (all P <0.05). On multivariable analysis, ≥ grade 3 vesicoureteral reflux (adjusted odds ratio 3.2, 95% confidence interval: 1.4, 7.6) and hydronephrosis (adjusted odds ratio 3.3, 95% confidence interval: 1.4, 7.9) were associated with enterococcal UTIs. Both groups had similar low risks of adverse events or severe clinical courses. The urine white blood cell count alone or in combination with leukocyte esterase was more sensitive for Gram-negative than enterococcal UTIs (range 80.4%-93.9% vs. 50.0%-75.9%). CONCLUSIONS Febrile infants with enterococcal UTIs had a low likelihood of adverse events or severe clinical course, similar to those with Gram-negative UTIs. Infants with enterococcal UTIs frequently had underlying hydronephrosis and/or vesicoureteral reflux. The preliminary diagnosis of enterococcal UTIs may be inaccurate if based on UA.
Collapse
|
11
|
Abstract
We reviewed the literature regarding bacteremia in early infancy (age ≤ 90 days). Bacteremia remains a major cause of morbidity and mortality in young infants. However, recent epidemiologic data suggest that the incidence of bacteremia is decreasing and the pathogens responsible for invasive disease are changing. These changes will impact the evaluation and management of young infants. We review the current epidemiology of community-acquired bacteremia in early infancy with particular emphasis on the causative agents, diagnostic evaluation, and empiric and definitive antimicrobial treatment.
Collapse
|
12
|
Acute focal bacterial nephritis, pyonephrosis and renal abscess in children. Pediatr Nephrol 2015; 30:1987-93. [PMID: 26076753 DOI: 10.1007/s00467-015-3141-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND-AIM Acute focal bacterial nephritis (AFBN), renal abscess and pyonephrosis are uncommon and not fully addressed forms of urinary tract infection (UTI) which may be underdiagnosed without the appropriate imaging studies. Here, we review the characteristics and outcome of these renal entities in children managed at a single medial centre. PATIENTS AND METHODS The medical files of all children hospitalized for episodes of AFBN, renal abscess and pyonephrosis during a 10-year period (2003-2012) were reviewed. RESULTS Among the 602 children hospitalized for UTI, 21 presented with AFBN, one with abscess and three with pyonephrosis. All 25 children (13 girls), ranging in age from 0.06 to 13.4 years, were admitted with fever and an impaired clinical condition, and 18 had urological abnormalities. More than one lesion, often of different types, were identified in 11 episodes. Urine cultures from 13 episodes grew non-Escherichia coli pathogens and those from two episodes were negative. Antibiotics were administered for 14-60 days, and emergency surgery was required in three cases. During follow-up, 13 patients underwent corrective surgery. Permanent renal lesions were identified in 16 patients. CONCLUSIONS AFBN, renal abscess and pyonephrosis should be suspected in children with severe presentation and urological history. Appropriate imaging is crucial for management planning. Prognosis is often guarded despite appropriate treatment. Based on the results of this study we propose a management algorithm.
Collapse
|
13
|
Kajihara T, Nakamura S, Iwanaga N, Oshima K, Takazono T, Miyazaki T, Izumikawa K, Yanagihara K, Kohno N, Kohno S. Clinical characteristics and risk factors of enterococcal infections in Nagasaki, Japan: a retrospective study. BMC Infect Dis 2015; 15:426. [PMID: 26471715 PMCID: PMC4608130 DOI: 10.1186/s12879-015-1175-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 10/05/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enterococcus spp. are particularly important etiological agents of nosocomial infections. However, the clinical characteristics of and risk factors for enterococcal infections in clinical settings are poorly understood. METHODS The sample included patients with Enterococcus spp. infections detected from clinical samples at Nagasaki University Hospital between 2010 and 2011 and patients with enterococcal colonization (control patients). In this retrospective study, the risk factors for enterococcal infections were analyzed by comparing infected and control patients via multivariate logistic regression. RESULTS A total of 182 infected (mean age, 64.6 ± 18.2 years; 114 men) and 358 control patients (patients with enterococcal colonization) (mean age, 61.6 ± 22.4 years; 183 men) were included. Enterococcal infections were classified as intraperitoneal (n = 87), urinary tract (n = 28), or bloodstream (n = 20) infections. Cancer and hematological malignancies were the most common comorbidities in enterococcal infections. Carbapenem and vancomycin were administered to 43.8 % and 57.9 % of patients infected with Enterococcus faecalis and Enterococcus faecium, respectively. No vancomycin-resistant enterococci were isolated. Multivariate analysis identified abdominal surgery (odds ratio [OR], 2.233; 95 % confidence interval [CI], 1.529-3.261; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.086; 95 % CI, 1.088-4.000; p = 0.027), male sex (OR, 1.504; 95 % CI, 1.032-2.190; p = 0.033), and hypoalbuminemia (OR, 0.731; 95 % CI, 0.555-0.963; p = 0.026) as independent risk factors for enterococcal infections. Multivariate analysis showed abdominal surgery (OR, 2.263; 95 % CI, 1.464-3.498; p ≤ 0.001), structural abnormalities of the urinary tract (OR, 2.634; 95 % CI, 1.194-5.362; p = 0.008), and hypoalbuminemia (OR, 0.668; 95 % CI, 0.490-0.911; p = 0.011) were independent risk factors for E. faecalis infection. Finally, immunosuppressive agent use (OR, 3.837; 95 % CI, 1.397-10.541; p = 0.009) and in situ device use (OR, 3.807; 95 % CI, 1.180-12.276; p = 0.025) were independent risk factors for E. faecium infection. CONCLUSIONS These findings might inform early initiation of antimicrobial agents to improve clinical success.
Collapse
Affiliation(s)
- Toshiki Kajihara
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. .,Department of Molecular and Internal Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan.
| | - Shigeki Nakamura
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. .,Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.
| | - Naoki Iwanaga
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kazuhiro Oshima
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Takahiro Takazono
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Taiga Miyazaki
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Koichi Izumikawa
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
| | - Nobuoki Kohno
- Department of Molecular and Internal Medicine, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan.
| | - Shigeru Kohno
- Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| |
Collapse
|
14
|
Rezaee MA, Abdinia B. Etiology and Antimicrobial Susceptibility Pattern of Pathogenic Bacteria in Children Subjected to UTI: A Referral Hospital-Based Study in Northwest of Iran. Medicine (Baltimore) 2015; 94:e1606. [PMID: 26426643 PMCID: PMC4616821 DOI: 10.1097/md.0000000000001606] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infection (UTI) is 1 of the most common bacterial diseases in children with a considerable resistance to antimicrobials. This 5 years prospective study was carried out to determine the frequency of isolation and antimicrobial resistance patterns of uropathogens among children subjected to urine culture at Tabriz Children Educational-Health Care Center, in the northwest of Iran. Organisms were isolated using standard culture techniques. Frequency of UTI among children examined by urine culture was 3.6%. The isolated bacteria were Escherichia coli (71.4%), followed by Klebsiella spp. (9.6%), Enterococcus spp. (6.4%), Pseudomonas aeruginosa (4.2%), Serratia spp. (4.2%), and Enterobacter spp. (4.2%). E coli resistance levels were 11% for nitrofurantoin, 15% for ciprofloxacin, 25% for nalidixic acid, and 30% to 75% for amikacin, gentamicin, ceftriaxone, ceftizoxime, cefotaxime, and co-trimoxazole. Among the tested antibiotics, ciprofloxacin, showed the highest activity (100%) against Klebsiella and P aeruginosa isolates followed by amikacin, nalidixic acid, and gentamicin. Overall, the highly active antibiotic against Gram-negative and Gram-positive organisms was amikacin and then ciprofloxacin. On the other hand, the empirical initial therapy with co-trimoxazole and third-generation cephalosporins would be inadequate for more cases of UTI in the study area. Moreover, susceptibility testing should be carried out on all clinical isolates, and the empirical antibiotic treatment changed accordingly.
Collapse
Affiliation(s)
- Mohammad Ahangarzadeh Rezaee
- From the Tabriz Infectious Diseases and Tropical Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran (MAR) and Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran (BA)
| | | |
Collapse
|
15
|
Abstract
Urinary tract infection (UTI) in an infant may be the first indication of an underlying renal disorder. Early recognition and initiation of adequate therapy for UTI is important to reduce the risk of long-term renal scarring. Ampicillin and gentamicin are traditionally the empiric treatment of choice; however, local antibiotic resistance patterns should be considered. Maternal antibiotics during pregnancy also increase the risk of resistant pathogens during neonatal UTI. Long-term management after the first UTI in infants remains controversial because of lack of specific studies in this age group and the risk-benefit issues for antibiotic prophylaxis between reduced recurrent disease and emergent antibiotic resistance.
Collapse
|
16
|
Bitsori M, Maraki S, Galanakis E. Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis. Pediatr Nephrol 2014; 29:1053-8. [PMID: 24362645 DOI: 10.1007/s00467-013-2719-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 11/04/2013] [Accepted: 11/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to identify long-term resistance trends of uropathogens and determine the effect of prophylaxis in a pediatric patient population. MATERIALS AND METHODS A total of 638 uropathogens were isolated from urine samples collected from children hospitalized for urinary tract infection during the 12-year study period (1997-2008) and analyzed. RESULTS The most frequent uropathogen identified was Escherichia coli (69 %), followed by Klebsiella spp. (9.7 %), Pseudomonas aeruginosa (6.7 %), Enterococcus spp. (5.6 %), and Proteus spp. (4.4 %). High resistance rates were observed for common agents used for empiric treatment, such as amoxicillin, cotrimoxazole, and ceftriaxone. Resistance increased over time for nitrofurantoin, ceftriaxone, and piperacilin-tazobactam (chi-square for trend p < 0.0002, p < 0.0034 and p < 0.014, respectively) and decreased for cefuroxime (p < 0.016) and gentamicin (p < 0.014). The use of prophylaxis was related to an increased proportion of non-E. coli pathogens (46.9 vs. 26.9 %; odds ratio 2.4, 95 % confidence interval 1.61-3.55; p < 0.0001), as well as to increased resistance of non-E. coli pathogens, and was a major risk factor associated with resistance to amoxiclav (p < 0.005), cotrimoxazole (p < 0.0001), cefuroxime (p < 0.0001), ceftriaxone (p < 0.0001), gentamicin (p < 0.0001), and nitrofurantoin (p < 0.0001). CONCLUSIONS Our findings point to considerable changes in the long-term resistance patterns of uropathogens and an association of prophylaxis with resistance. Our results suggest the need for continuous surveillance, re-evaluation of empiric regimens and further assessment of the role of prophylaxis in the treatment of urinary tract infection.
Collapse
Affiliation(s)
- Maria Bitsori
- Department of Paediatrics, University Hospital of Heraklion, Crete, Greece
| | | | | |
Collapse
|
17
|
Variation in antibiotic susceptibility of uropathogens by age among ambulatory pediatric patients. J Pediatr Nurs 2014; 29:152-7. [PMID: 24091131 PMCID: PMC3943820 DOI: 10.1016/j.pedn.2013.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 07/30/2013] [Accepted: 09/05/2013] [Indexed: 11/20/2022]
Abstract
We compared uropathogen antibiotic susceptibility across age groups of ambulatory pediatric patients. For Escherichia coli (n=5,099) and other Gram-negative rods (n=626), significant differences (p<0.05) existed across age groups for ampicillin, cefazolin, and trimethoprim/sulfamethoxazole susceptibility. In E. coli, differences in trimethoprim/sulfamethoxazole susceptibility varied from 79% in children under 2 to 88% in ages 16-18 (p<0.001), while ampicillin susceptibility varied from 30% in children under 2 to 53% in ages 2-5 (p=0.015). Uropathogen susceptibility to common urinary anti-infectives may be lower in the youngest children. Further investigation into these differences is needed to facilitate appropriate and prudent treatment of urinary tract infections.
Collapse
|
18
|
Marcus N, Ashkenazi S, Samra Z, Cohen A, Livni G. Community-acquired enterococcal urinary tract infections in hospitalized children. Pediatr Nephrol 2012; 27:109-14. [PMID: 21822790 DOI: 10.1007/s00467-011-1951-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/12/2011] [Accepted: 05/17/2011] [Indexed: 11/29/2022]
Abstract
The objectives of this study were to characterize community-acquired (CA) enterococcal urinary tract infections (UTIs) in a tertiary pediatric center and to determine risk factors for their occurrence, their association with renal abnormalities, their antibiotic susceptibility profile, and the appropriateness of the empiric antibiotic treatment, in comparison to those of Gram-negative UTIs. In a 5-year prospective clinical and laboratory study, we found that enterococcal UTIs caused 6.2% (22/355) of culture-proven CA UTIs. Compared with Gram-negative UTI, enterococcal UTI was associated with male predominance, higher rates of underlying urinary abnormalities (70 vs. 43.7%; p = 0.03) and inappropriate empiric antibiotic therapy (22 vs. 5.6%; p = 0.02), and mainly vesicoureteral reflux (53% of cases). This study highlights the importance of early detection of CA enterococcal UTIs because of their association with underlying urinary abnormalities and a high rate of inappropriate empiric antibiotic therapy. Renal imaging is recommended for children with enterococcal UTIs; Gram stain is suggested in selected cases to detect Gram-positive cocci for early diagnosis of enterococcal UTIs and initiation of appropriate antibiotics.
Collapse
Affiliation(s)
- Nir Marcus
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel
| | | | | | | | | |
Collapse
|
19
|
Pseudomonas Aeruginosa Urinary Tract Infection in Children: Risk Factors and Outcomes. J Urol 2012; 187:260-4. [DOI: 10.1016/j.juro.2011.09.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Indexed: 11/17/2022]
|
20
|
Abstract
Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines.
Collapse
|
21
|
Chesney RW, Carpenter MA, Moxey-Mims M, Nyberg L, Greenfield SP, Hoberman A, Keren R, Matthews R, Matoo TK. Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR): background commentary of RIVUR investigators. Pediatrics 2008; 122 Suppl 5:S233-9. [PMID: 19018047 PMCID: PMC4336951 DOI: 10.1542/peds.2008-1285c] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Because of the frequency of urinary tract infections in children, off-label use of antimicrobial prophylaxis is often the usual treatment of children with vesicoureteral reflux, and such use is increasingly being called into question; hence, a definitive study to determine the value of antimicrobial prophylaxis with regard to the recurrence of urinary tract infection and the incidence of renal scarring is essential. The currently recommended follow-up procedures (repeated urine cultures, renal and genitourinary imaging, antimicrobial therapy and prophylaxis, as well as other factors including cleanliness, adequate bladder and bowel emptying, and compliance with protocols) are expensive (in terms of time, attention to detail, and cost) and cumbersome. Such recommendations should be evidence-based.
Collapse
Affiliation(s)
- Russell W. Chesney
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Myra A. Carpenter
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Marva Moxey-Mims
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Leroy Nyberg
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Alejandro Hoberman
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ron Keren
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ron Matthews
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Tej K. Matoo
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | | |
Collapse
|
22
|
Hiraga N, Muratani T, Naito S, Matsumoto T. Genetic analysis of faropenem-resistant Enterococcus faecalis in urinary isolates. J Antibiot (Tokyo) 2008; 61:213-21. [PMID: 18503200 DOI: 10.1038/ja.2008.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We isolated faropenem-resistant Enterococcus faecalis in urine specimens and studied the mechanisms of resistance to faropenem in these isolates. Three mechanisms of penicillin resistance have been reported in E. faecalis; (1) beta-lactamase production, (2) overproduction of penicillin-binding protein (PBP) 4 or PBP5, and (3) decreasing affinities of penicillins for PBP4 by the occurrence of point mutations of the penicillin-binding domain. None of the E. faecalis isolates examined produced beta-lactamase or overproduced any PBPs, but the affinities of faropenem for PBP4 were decreased in faropenem-insensitive and -resistant strains. We found single amino acid substitutions at positions 475, 520 or 605 in PBP4 in the insensitive strains and two amino acid substitutions at positions 520 and 605 in PBP4 in the resistant strains by sequencing the entire pbp4 gene from each isolate. We conclude that development of resistance to faropenem in E. faecalis is due to decreasing affinities for PBP4 that are the result of the occurrence of one or two point mutations.
Collapse
Affiliation(s)
- Noriyuki Hiraga
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | | | | |
Collapse
|
23
|
Clinical features of community-acquired Pseudomonas aeruginosa urinary tract infections in children. Pediatr Nephrol 2008; 23:765-8. [PMID: 18299898 DOI: 10.1007/s00467-007-0697-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 10/25/2007] [Accepted: 10/26/2007] [Indexed: 10/22/2022]
Abstract
This retrospective chart review sought to determine clinical, radiological, and gender-associated characteristics of community-acquired Pseudomonas aeruginosa (PA) urinary tract infections (UTIs) among children admitted to two medical centers. The records of 73 children with community-acquired PA UTIs were compared with records of 109 children with community-acquired UTIs caused by other pathogens. The mean age of both groups was similar. The PA UTI group included more boys. Features significantly more common in the PA UTI group were the number of patients who had undergone urinary tract surgery, patients with skeletal and/or neurological malformation, patients with >1 previous episode of UTI, patients on prophylactic antibiotic treatment on admission, and patients with pathological renal ultrasound and voiding cystourethrography (VCUG) findings. Multivariate logistic regression analysis revealed the following to be associated with PA UTI: >1 episode of UTI in the past [odds ratio (OR) = 35.5; 95% confidence interval (CI) 11.6-108.7], previous urinary tract surgery (OR = 34.1; 95% CI 7.00-166.2), and pathological VCUG results (OR = 2.62; 95% CI 0.96-7.15). In conclusion, PA UTI is associated with >1 previous UTI, urinary tract abnormalities, and past urinary tract surgery. We recommend that when UTI is suspected in children with these risk factors, a thorough radiologic investigation, including a VCUG, should be considered.
Collapse
|
24
|
Eiros Bouza JM, Ochoa Sangrador C. [Etiological profile of urinary tract infections and antimicrobial susceptibility of urinary pathogens]. An Pediatr (Barc) 2008; 67:461-8. [PMID: 17991366 DOI: 10.1016/s1695-4033(07)70713-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A review on the etiological profile of urinary tract infections in childhood and the sensitivity pattern of urinary pathogens in Spain is presented. Escherichia coli continues to be the main etiological agent of urinary tract infection in childhood. Consequently, its sensitivity pattern will usually determine the choice of empirical therapy. The predominance of E. coli is reduced in certain circumstances, in which the presence of other microorganisms is increased. However, the clinical information available at diagnosis does not allow accurate identification of the etiology; only staining and microscopic urine examination can help in treatment selection. In Spain, E. coli presents a high percentage of resistance to ampicillin and cotrimoxazole, whereas second- and third-generation cephalosporins, fosfomycin, aminoglycosides and amoxicillin-clavulanate maintain high sensitivity. In some areas, amoxicillin-clavulanate and first-generation cephalosporins show high levels of resistance, which can limit their empirical use.
Collapse
Affiliation(s)
- J M Eiros Bouza
- Servicio de Microbiología. Hospital Clínico Universitario. Valladolid, España
| | | | | |
Collapse
|
25
|
Anatoliotaki M, Galanakis E, Schinaki A, Stefanaki S, Mavrokosta M, Tsilimigaki A. Antimicrobial resistance of urinary tract pathogens in children in Crete, Greece. ACTA ACUST UNITED AC 2007; 39:671-5. [PMID: 17654342 DOI: 10.1080/00365540701199899] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of the present study was to identify the organisms responsible for community acquired febrile UTI in children and to investigate their susceptibility to commonly used antibiotics. A 5-y prospective analysis was performed in children hospitalized for a first episode of UTI, in Crete, Greece. A total of 262 children, 40.1% males and 59.9% females, aged 0.08 to 13 y, were enrolled in the study. Escherichia coli (E. coli) was the leading uropathogen. Antimicrobial resistance of E. coli isolates was most commonly to ampicillin (56.4%) followed by trimethoprim-sulfamethoxazole (TMP-SMX) (27.3%), cefaclor (22.5%), amoxicillin-clavulanate (15.5%), gentamicin (4.9%), cefuroxime (3.1%), nitrofurantoin (2.6%), and ceftriaxone (1.6%). Interestingly, a significant decrease in E. coli resistance to TMP-SMX was observed during the study period. Resistance to ampicillin, TMP-SMX and cefaclor was noted for 61%, 28% and 27% of the total uropathogens, respectively, making these agents inappropriate for empirical treatment of febrile UTI in our region. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate. More than 90% of the uropathogens are susceptible to cefuroxime, ceftriaxone, gentamicin, and nitrofurantoin. In conclusion, several of the first-line agents for empirical treatment of childhood UTI seem to have become ineffective in the area of this study.
Collapse
Affiliation(s)
- Maria Anatoliotaki
- Department of Paediatrics, Venizelion General Hospital, Heraklion, Crete, Greece
| | | | | | | | | | | |
Collapse
|
26
|
|
27
|
Abstract
From relative obscurity, enterococci have become a leading cause of nosocomial infection. This has been attributed, in part, to the growth in susceptible host populations, increased use of intravascular devices, prolonged hospital stay, and widespread antibiotics use. Furthermore, the facility with which enterococci acquire resistance characteristics coupled with their capacity to survive in the environment renders them uniquely suited as nosocomial opportunists and have resulted in global dissemination of resistant strains. Debate continues as to whether most serious infections arise from a person's indigenous flora or dissemination of virulent clones. Enterococci are normal inhabitants of the human gastrointestinal tract. Classically associated with endocarditis and wound and urinary tract infections, increasingly they are a cause of nosocomial bacteremia. The rise in incidence of serious enterococcal infection has been particularly evident in neonatal, paediatric intensive care, and haematology/oncology units. Spread of resistant phenotypes has posed a difficult therapeutic challenge. We have been rescued, albeit perhaps only temporarily, by the addition of newer agents, such as linezolid, to the therapeutic armamentarium. However, there is no room for complacency. Linezolid resistance already has been reported. Efforts must continue to focus on prevention of the emergence and dissemination of resistance through policies of rational antibiotic use, infection control and education.
Collapse
Affiliation(s)
- Karina M Butler
- Pediatric Infectious Diseases, Our Lady's Children's Hospital Crumlin & The Children's University Hospital, Dublin, Ireland.
| |
Collapse
|
28
|
Colodner R, Eliasberg T, Chazan B, Raz R. Clinical significance of bacteriuria with low colony counts of Enterococcus species. Eur J Clin Microbiol Infect Dis 2006; 25:238-41. [PMID: 16596356 DOI: 10.1007/s10096-006-0132-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The clinical significance of low counts of enterococci in urine cultures remains unclear. The goal of this study was to investigate the clinical significance of enterococci growing in numbers lower than 100,000 colony-forming units per milliliter (cfu/ml) in urine samples. Clinical parameters were collected from patients whose midstream clean-catch urine samples grew Enterococcus spp. in amounts between >or=10,000 and 100,000 cfu/ml and who were not previously treated with antibiotics. Only those patients who had leukocyturia in addition to positive culture were considered to have true urinary tract infection (UTI). Of the 208 patients included in the study, 54% were diagnosed with true UTI. Patients with true UTI were older by 6 years (p=0.03), were more likely to be hospitalized (p=0.016), had higher rates of dysuria (p=0.0001), urgency (p=0.0001), and frequency (p=0.0001), and had more solid tumors (p=0.03). By multivariate analysis, urgency (OR=7.1) and hospitalization (OR=4.4) were identified as independent risk factors for true UTI with enterococci in low counts. Enterococcal counts in patients with true UTI were randomly distributed all along the scale between 10,000 and 100,000 cfu/ml, and no differential cutoff could be determined. In conclusion, more than half of the patients whose urine cultures grow Enterococcus spp. in counts lower than 100,000 cfu/ml may have true UTI, especially if they are hospitalized and have symptoms of dysuria, urgency, or frequency. Microbiology laboratories should perform a complete work-up on samples containing low counts of enterococci, and the final interpretation should be done by physicians, using additional clinical information.
Collapse
Affiliation(s)
- R Colodner
- Clinical Microbiology Laboratory, Ha'Emek Medical Center, 18101 Afula, Israel.
| | | | | | | |
Collapse
|
29
|
Abstract
Pediatric urinary tract infections are common. These infections have been recognized as a source of acute morbidity and long-term medical consequences in adulthood. There are various risk factors and clinical presentations in children with urinary tract infections. The main objectives in management include prompt diagnosis, appropriate antimicrobial therapy, identification of anatomic anomalies, and, in select patients, long-term follow-up.
Collapse
Affiliation(s)
- Steven L Chang
- Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, CA 94305-2200, USA
| | | |
Collapse
|