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Qusad M, Elhalabi I, Ali S, Siddiq K, Loay L, Aloteiby A, Al Ansari G, Moustafa B, Olukade T, Al Amri M, Soliman A, Khalil A. Urinary Tract Infections among Febrile Infants in Qatar: Extended-Spectrum-Beta-Lactamase (ESBL)-Producing Versus Non-ESBL Organisms. Antibiotics (Basel) 2024; 13:547. [PMID: 38927213 PMCID: PMC11200522 DOI: 10.3390/antibiotics13060547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/04/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The escalating prevalence of ESBL-producing Enterobacteriaceae in Qatar's pediatric population, especially in community-onset febrile urinary tract infections (FUTIs), necessitates a comprehensive investigation into this concerning trend. RESULTS Over the course of one year, a total of 459 infants were diagnosed and subsequently treated for UTIs. Cases primarily occurred in infants aged over 60 days, predominantly non-Qatari females born from term pregnancies. Notably, E. coli and K. pneumoniae were the most frequently identified organisms, accounting for 79.7% and 9.8% in the ESBL group and 57.2% and 18.7% in the non-ESBL group, respectively. Interestingly, hydronephrosis emerged as the most prevalent urological anomaly detected in both ESBL (n = 10) and other organism (n = 19) groups. METHODS In this retrospective cohort study conducted in Qatar, we meticulously evaluated the prevalence of pediatric FUTIs. Our study focused on febrile infants aged less than 1 year, excluding those with urine samples not obtained through a catheter. CONCLUSIONS E. coli and K. pneumoniae prevailed as the predominant causative agents in febrile children in Qatar, with hydronephrosis being identified as the most common urological anomaly. Moreover, our findings suggested that gentamicin served as a viable non-carbapenem option for hospitalized ESBL cases, while oral nitrofurantoin showed considerable promise for uncomplicated ESBL UTIs.
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Affiliation(s)
- Mohammad Qusad
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Ihsan Elhalabi
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Samer Ali
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Khaled Siddiq
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Lujain Loay
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Abdallah Aloteiby
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Ghada Al Ansari
- Department of Clinical Chemistry Laboratory, Hamad General Hospital, Doha 3050, Qatar;
| | - Bassem Moustafa
- Section of Academic General Pediatrics, Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (M.Q.); (I.E.); (S.A.); (K.S.); (L.L.); (A.A.); (B.M.)
| | - Tawa Olukade
- Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (T.O.); (M.A.A.); (A.S.)
| | - Mohammed Al Amri
- Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (T.O.); (M.A.A.); (A.S.)
| | - Ashraf Soliman
- Department of Pediatrics, Hamad General Hospital, Doha 3050, Qatar; (T.O.); (M.A.A.); (A.S.)
| | - Ahmed Khalil
- Section of Pediatric Clinical Pharmacy, Pharmacy Department, Hamad General Hospital, Doha 3050, Qatar
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Majigo MV, Mshana S, Komba E, Moremi N, Matee M. Protocol for surveillance of antimicrobial-resistant bacteria causing community-acquired urinary tract infections in low-income countries. PLoS One 2024; 19:e0304388. [PMID: 38820392 PMCID: PMC11142477 DOI: 10.1371/journal.pone.0304388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/12/2024] [Indexed: 06/02/2024] Open
Abstract
The spread of drug-resistant bacteria into the community is an urgent threat. In most low-middle-income countries (LMICs) settings, community-acquired infection (CAI) is empirically treated with no data to support the choice of antibiotics, hence contributing to resistance development. Continuous antimicrobial resistance (AMR) data on community-acquired pathogens are needed to draft empirical treatment guidelines, especially for areas with limited culture and susceptibility testing. Despite the importance of addressing antibiotic-resistant pathogens in the community setting, protocols for the surveillance of AMR bacterial infections are lacking in most (LMICs). We present a protocol for surveillance of AMR in LMICs using urinary tract infection (UTI) as a proxy for CAI to enable users to quantify and establish the drivers of AMR bacteria causing UTI. The protocol intends to assist users in designing a sustainable surveillance program for AMR in the community involving children above two years of age and adults presenting to a primary health facility for healthcare. Implementation of the protocol requires initial preparation of the laboratories to be involved, surveillance areas, selection of priority bacteria and antimicrobials to be used, and the design of a coordinated sampling plan. Recruitment should occur continuously in selected health facilities for at least 12 months to observe seasonal trends of AMR. At least 10 mL of clean-catch mid-stream urine must be collected into 20 mL calibrated sterile screw-capped universal bottles lined with 0.2 mg boric acid and transported to the testing laboratory. Utilise the data system that generates standard reports for patient care to be shared internally and externally in the regions and the world through global platforms such as the Global Antimicrobial Resistance Surveillance System.
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Affiliation(s)
- Mtebe Venance Majigo
- SACIDS Foundation for One Health, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen Mshana
- SACIDS Foundation for One Health, Dar es Salaam, Tanzania
- Catholic University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Erick Komba
- SACIDS Foundation for One Health, Dar es Salaam, Tanzania
- Sokoine University of Agriculture, Morogoro, Tanzania
| | - Nyambura Moremi
- SACIDS Foundation for One Health, Dar es Salaam, Tanzania
- National Health Laboratory Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Mecky Matee
- SACIDS Foundation for One Health, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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He XT, Chang CN, Yu CH, Wang CC. The risk factors, antimicrobial resistance patterns, and outcomes associated with extended-spectrum β-lactamases-Producing pathogens in pediatric urinary tract infection. Pediatr Neonatol 2024; 65:242-248. [PMID: 37951832 DOI: 10.1016/j.pedneo.2023.04.021] [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] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Extended-spectrum β-lactamases-producing Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis (ESBL-producing-EKP) are an increasingly common cause of childhood urinary tract infection (UTI) worldwide. Recognizing the risk factors and antimicrobial resistance patterns may guide new management in this population. METHODS This is a retrospective cohort study of over 5 years in Taiwan (2017-2021). Inclusion criteria are hospitalized pediatric patients with the discharge diagnosis of UTI caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis. ESBL-producing-EKP and non-ESBL-producing-EKP UTI cases were reviewed for characteristics, urinary isolate antibiotics resistance, and clinical outcomes. RESULTS The incidence rate of ESBL-producing-EKP UTI increased over the study period (Overall incidence rate: 14.1 %, 46/327 patients). Recent antibiotic therapy in ≤6 months (X2 = 11.83, p < 0.01) and a preterm gestational history (X2 = 8.11, p < 0.05) were associated with an increased risk. The proportion of patients with these two risk factors for ESBL acquisition were 37.5 % (X2 = 9.08, p < 0.05). The co-resistance rate of ESBL-producing-EKP to other antimicrobial agents was 63.0 % for gentamicin, 56.5 % for trimethoprim-sulfamethoxazole, 52.2 % for ciprofloxacin, 4.3 % for amikacin, and 2.2 % for imipenem. The generalized linear model analysis identified a significantly longer length of stay (β: 2.85; 95 % confidence interval [CI]: 1.14-4.56; p < 0.01) and intensive care unit duration (β: 5.86; 95 % CI: 1.59-10.12; p < 0.01) among patients with ESBL-producing-EKP UTI. CONCLUSION Amikacin should be considered as an alternative antimicrobial choice beyond carbapenems for ESBL-producing-EKP UTI, especially in the context of carbapenem-resistant E. coli/Klebsiella pneumoniae (CRE/CRKP) emergence.
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Affiliation(s)
- Xin-Tian He
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ning Chang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Hsiang Yu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Park KS, Kim DR, Baek JY, Shin A, Kim KR, Park H, Son S, Cho H, Kim YJ. Susceptibility to Fosfomycin and Nitrofurantoin of ESBL-Positive Escherichia coli and Klebsiella pneumoniae Isolated From Urine of Pediatric Patients. J Korean Med Sci 2023; 38:e361. [PMID: 38084025 PMCID: PMC10713444 DOI: 10.3346/jkms.2023.38.e361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pediatric urinary tract infection (UTI) caused by extended-spectrum β-lactamase (ESBL)-positive gram-negative bacilli (GNB) has limited options for oral antibiotic treatment. The purpose of this study was to investigate the susceptibility of ESBL-positive Escherichia coli and Klebsiella pneumoniae isolates from pediatric urine samples to two oral antibiotics (fosfomycin and nitrofurantoin). METHODS From November 2020 to April 2022, ESBL-positive E. coli and K. pneumoniae isolates from urine samples were collected at Samsung Medical Center, Seoul, Korea. Patients over 18 years of age or with malignancy were excluded. For repeated isolates from the same patient, only the first isolate was tested. Minimum inhibitory concentrations (MICs) were measured using agar (fosfomycin) or broth (nitrofurantoin) dilution methods. MIC50 and MIC90 were measured for fosfomycin and nitrofurantoin in both E. coli and K. pneumoniae. RESULTS There were 117 isolates from 117 patients, with a median age of 7 months (range, 0.0-18.5 years). Among 117 isolates, 92.3% (108/117) were E. coli and 7.7% (9/117) were K. pneumoniae. Isolates from the pediatric intensive care unit (PICU) and general ward (GW) was 11.1% (13/117) and 88.9% (104/117), respectively. Among 108 E. coli isolates, MIC50 and MIC90 for fosfomycin were 0.5 μg/mL and 2 μg/mL, respectively. Fosfomycin susceptibility rate was 97.2% (105/108) with a breakpoint of 128 μg/mL. Fosfomycin susceptibility rate was significantly lower in PICU isolates than in GW isolates (81.8% vs. 99.0%, P = 0.027). For nitrofurantoin, both the MIC50 and MIC90 were 16 μg/mL. Nitrofurantoin susceptibility rate was 96.3% (104/108) with a breakpoint of 64 μg/mL based on Clinical and Laboratory Standards Institute guidelines. Among the nine K. pneumoniae isolates, the MIC50 and MIC90 for fosfomycin was 2 μg/mL and 32 μg/mL, respectively. MIC50 and MIC90 for nitrofurantoin were 64 μg/mL and 128 μg/mL, respectively. CONCLUSION For uncomplicated UTI caused by ESBL-positive GNB in Korean children, treatment with fosfomycin and nitrofurantoin for E. coli infections can be considered as an effective oral therapy option.
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Affiliation(s)
- Ki-Sup Park
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Planning Team, SML Genetree, Seoul, Korea
| | - Doo Ri Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Yang Baek
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
| | - Areum Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ran Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Hwanhee Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sohee Son
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
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Khatoon I, Khanam S, Azam A, Qadeer S, Naz S, Hassan NU. Incidence Pattern, Antibiotic Susceptibility Pattern and Associated Risk Factors of Bacterial Uropathogens Among General Population of Pakistan. Infect Drug Resist 2023; 16:4995-5005. [PMID: 37551281 PMCID: PMC10404436 DOI: 10.2147/idr.s418045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/21/2023] [Indexed: 08/09/2023] Open
Abstract
Purpose Urinary tract infections (UTIs) are of the most common bacterial infections in Pakistan. Rapid increase in antibiotic resistance has resulted in a limited number of treatment options available. This study aimed to determine the incidence patterns of uropathogens, their antimicrobial susceptibility pattern and risk factors for UTI among the general population. Methods This laboratory-based cross-sectional study was conducted between November 2020 and March 2021. Urine samples were collected, cultured and bacterial isolates were identified. Bacterial isolates were tested for antimicrobial susceptibility. Data regarding socio-demographic characteristics, clinical features and risk factors were collected using structured questionnaire. Results Of 459 urine samples, 299 (65.1%) showed positive urine cultures (105 CFU/mL). Both gram-negative and gram-positive isolates were obtained, with a prevalence of 230 (76.9%) and 69 (23%), respectively. Escherichia coli was the predominant bacteria isolated 146 (48.8%), and it showed most susceptibility to cefoperazone and imipenem. Most of the gram-negative isolates were resistant towards ampicillin. Most risk factors were not significantly associated with UTI, except for age, income, and previous history of hospitalization. Conclusion UTI is an important problem in the study area, with a prevalence rate of 65%. All bacterial isolates developed resistance towards most antibiotics available on the market. Therefore, there is a need to develop management strategies based on susceptibility pattern of uropathogens. Additionally, proper public education regarding causes of disease transmission and control strategies is required.
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Affiliation(s)
- Iram Khatoon
- Department of Zoology, Women University Swabi, Swabi, Khyber Pakhtunkhwa, Pakistan
| | - Surrya Khanam
- Department of Zoology, Women University Swabi, Swabi, Khyber Pakhtunkhwa, Pakistan
| | - Asima Azam
- Department of Zoology, Shaheed Benazir Bhutto Women University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Saima Qadeer
- Department of Zoology, Division of Science & Technology, University of Education Lahore, Lahore, Punjab, 54000, Pakistan
| | - Shumaila Naz
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Punjab, Pakistan
| | - Najm Ul Hassan
- Department of Microbiology, Abdul Wali Khan University, Mardan, Khyber Pakhtunkhwa, Pakistan
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Alsubaie MA, Alsuheili AZ, Aljehani MN, Alothman AA, Alzahrani AS, Mohammedfadel HA, Alnajjar AA. Pediatric community acquired urinary tract infections due to extended-spectrum beta-lactamase versus non-extended-spectrum beta-lactamase producing bacteria. Pediatr Int 2023; 65:e15620. [PMID: 37735838 DOI: 10.1111/ped.15620] [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] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND This study aimed to evaluate the demographics, clinical characteristics, risk factors, and antibiotic resistance of pediatric community-acquired urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing uropathogens. METHODS This retrospective study was conducted at a tertiary care hospital in Saudi Arabia, among children aged between 0 and 14 years, with a culture-proven diagnosis of community-acquired UTI between February 2019 and September 2021. Patients were divided into two groups based on whether or not their UTI was caused by ESBL-producing bacteria. RESULTS A total of 383 patients with community-acquired UTI were evaluated. Escherichia coli was detected in 72.6% of cultures. Extended-spectrum beta-lactamase-producing organisms were responsible for 35.7% of UTI episodes. Of these 69% and 31% were caused by E. coli and Klebsiella pneumoniae, respectively. There were no significant differences between the two groups with regard to clinical presentation or urine analysis. The resistance rates in the ESBL-producing group were 39.4% for amoxicillin/clavulanic acid, 65.7% for ciprofloxacin, 72.3% for co-trimoxazole, 32.8% for nitrofurantoin, 21.2% for gentamicin, and 0.7% for amikacin and carbapenems. In the non-ESBL-producing group, it was 22.4% for amoxicillin/clavulanic acid, 22.4% for ciprofloxacin, 38.2% for co-trimoxazole, 23.6% for nitrofurantoin, 6.1% for gentamicin, and zero for amikacin and carbapenems. The presence of renal abnormalities (p = 0.014) and male gender (p = 0.026) were determined to be independent risk factors for ESBL UTIs. CONCLUSIONS Recognizing risk factors and antibiotic resistance for ESBL-producing bacteria may aid in tailoring an antibiotic regimen for pediatric patients at high risk of ESBL-UTIs.
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Affiliation(s)
| | | | | | | | | | | | - Abeer A Alnajjar
- Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Ohnishi T, Mishima Y, Naito T, Matsuda N, Ariji S, Umino D, Tamura K, Nishimoto H, Kinoshita K, Maeda N, Kawaguchi A, Yonezawa R, Mimura S, Fukushima H, Nanao K, Yoshida M, Sekijima T, Kamimaki I. Clinical features and treatment strategies of febrile urinary tract infection caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: a multicenter retrospective observational study in Japan. Int J Infect Dis 2022; 125:97-102. [PMID: 36180033 DOI: 10.1016/j.ijid.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The incidence of infections caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria has increased. This study aimed to clarify the risk factors and treatment strategies for febrile urinary tract infection (fUTI) caused by ESBL-producing bacteria in Japanese children. METHODS A retrospective observational study was conducted in 21 hospitals among children aged <16 years diagnosed with an fUTI between 2008 and 2017. Clinical data of children with fUTI caused by ESBL-producing and non-ESBL-producing bacteria were compared. RESULTS Of the 2049 cases of fUTI, 147 (7.2%) were caused by ESBL-producing bacteria. Children in the ESBL group were more likely to have a history of recent antibiotic use or prophylactic antibiotic use, and experience recurrent UTIs (P <0.001) compared with those in the non-ESBL group. Of the 124 cases of fUTI due to ESBL-producing bacteria that were reviewed, 20 and 100 had concordant and discordant antibiotic use, respectively, and four had unknown antibiotic susceptibility. The median time from the start of treatment to fever resolution was 24 hours and did not differ significantly by therapy group (P = 0.39). CONCLUSION ESBL-producing bacteria should be considered in children with recurrent UTIs and recent antibiotic use. Most children with fUTI experience clinical improvement regardless of the choice of antibiotic.
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Affiliation(s)
- Takuma Ohnishi
- Department of Pediatrics, National Hospital Organization Saitama Hospital, Saitama, Japan; Department of Pediatrics, Keio Univerisity School of Medicine, Tokyo, Japan.
| | - Yoshinori Mishima
- Department of Pediatrics, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Tomomi Naito
- Department of Pediatrics, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Nozomi Matsuda
- Department of Pediatrics, Soka Municipal Hospital, Saitama, Japan
| | - Shohei Ariji
- Department of Pediatrics, Kawaguchi Municipal Medical Center, Saitama, Japan
| | | | - Kikuko Tamura
- Department of Pediatrics, National Hospital Organization Nishisaitama-chuo National Hospital, Saitama, Japan
| | - Hajime Nishimoto
- Department of Pediatrics, Saitama Citizens Medical Center, Saitama, Japan
| | - Keiji Kinoshita
- Department of Pediatrics, Koshigaya Municipal Hospital, Saitama, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Azusa Kawaguchi
- Department of Pediatric Nephrology, National Hospital Organization Hokkaido Medical Center, Hokkaido, Japan
| | - Ryuta Yonezawa
- Department of Pediatrics, IMS Fujimi General Hospital, Saitama, Japan
| | - Shigenao Mimura
- Department of Pediatrics, Ageo Central General Hospital, Saitama, Japan
| | - Hiroyuki Fukushima
- Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Kenji Nanao
- Department of Pediatrics, Hino Municipal Hospital, Tokyo, Japan
| | - Makoto Yoshida
- Department of Pediatrics, Sano Kosei General Hospital, Tochigi, Japan
| | - Toshio Sekijima
- Department of Pediatrics, Hanyu General Hospital, Saitama, Japan
| | - Isamu Kamimaki
- Department of Pediatrics, National Hospital Organization Saitama Hospital, Saitama, Japan
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Kavruk M, Soyaltın E, Erfidan G, Arslansoyu Çamlar S, Alaygut D, Mutlubaş F, Yılmaz N, Kasap Demir B. The Influence of Non-E. Coli or Extended-Spectrum β-Lactamase-Producing Bacterial Growth on the Follow-Up Procedure of Infants with the First Febrile Urinary Tract Infection. Indian J Pediatr 2022:10.1007/s12098-022-04183-3. [PMID: 35727527 DOI: 10.1007/s12098-022-04183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/27/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the effects of non-E. coli or extended-spectrum β-lactamase-positive (ESBL-positive) microorganism growth in the first febrile urinary tract infection (UTI) of infants on laboratory findings or renal parenchymal damage presenting the severity of inflammation, anatomic abnormalities defined by imaging studies, and recurrent UTIs in the follow-up period. METHODS The data of patients aged between 2 and 24 mo and followed up for at least 6 mo with febrile UTI guideline of the authors' pediatric-nephrology clinic, were retrospectively analyzed. Ultrasonography was performed in all the cases at the time of UTI and dimercaptosuccinic-acid (DMSA) at least 4 mo after the infection. Voiding cystourethrography (VCUG) was performed only if ultrasonography findings were abnormal, the uptake deformity was detected in DMSA scan, or the patients experienced recurrent UTIs. The patients were grouped concerning E. coli or non-E. coli and ESBL-PB or non-ESBL-BP growth in the urine cultures. RESULTS There were 277 infants followed up for 28.55 ± 15.24 (6-86) mo. The causative microorganisms were non-E. coli in 73 (26.4%) and ESBL-PB in 58 (20.9%) cases. CRP values, pyuria, and leukocyte-esterase positivity were significantly higher in UTIs caused by E. coli compared to non-E. coli bacteria. All clinical and laboratory findings were similar between the ESBL-PB and non-ESBL groups, but abnormal ultrasonography findings were more common in non-E. coli group. CONCLUSION E. coli causes more severe inflammation, but non-E. coli infections are more frequently associated with ultrasound abnormalities. However, ESBL production did not affect either laboratory or radiological findings in the present cohort.
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Affiliation(s)
- Mustafa Kavruk
- Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Eren Soyaltın
- Department of Pediatrics, Division of Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, 35320, Turkey
| | - Gökçen Erfidan
- Department of Pediatrics, Division of Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, 35320, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatrics, Division of Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, 35320, Turkey.
| | - Demet Alaygut
- Department of Pediatrics, Division of Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, 35320, Turkey
| | - Fatma Mutlubaş
- Department of Pediatrics, Division of Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, 35320, Turkey
| | - Nisel Yılmaz
- Department of Clinical Microbiology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatrics, Division of Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, İzmir, 35320, Turkey.,Department of Pediatrics, Division of Nephrology and Rheumatology, Izmir Katip Çelebi University Medical Faculty, İzmir, Turkey
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Lu J, Wang L, Wei Y, Wu S, Wei G. Trends and risk factors of extended-spectrum beta-lactamase urinary tract infection in Chinese children: a nomogram is built and urologist should act in time. Transl Pediatr 2022; 11:859-868. [PMID: 35800289 PMCID: PMC9253944 DOI: 10.21037/tp-21-523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the etiological characteristics and risk factors of extended-spectrum beta-lactamase (ESBL) urinary tract infection (UTI) and construct a corresponding nomogram to predict the probability of ESBL(+) UTI. METHODS We retrospectively reviewed the records among patients experiencing UTI events in Chongqing Medical University Affiliated Children's Hospital from 1994 and 2019. RESULTS A total of 854 patients with UTI were evaluated and ESBL-producing bacteria increased significantly. Significant potential risk factors of ESBL-UTI were congenital urological abnormalities, vesicoureteral reflux, neurologic disorder, age <12 months, fever and previous use of antibiotics. On logistic regression analysis, neurological disorder (OR =8, 95% CI: 1.845-34.695) and antibiotics administration in the last 3 months (OR =4.764, 95% CI: 3.114-7.289) were identified as an independent significant risk factor for ESBL-UTI. The nomogram generated was well calibrated for all predictions of ESBL+ probability, and the accuracy of the model nomogram measured by Harrell's C statistic (C-index) was 0.741. CONCLUSIONS The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI and early identification of ESBL production is important in terms of appropriate treatment and effective infection control. We may choose broad-spectrum antibiotics as empirical antibiotics for UTI among children with neurological disease and used antibiotic in the last three months.
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Affiliation(s)
- Jiandong Lu
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Lin Wang
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Yi Wei
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Shengde Wu
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Guanghui Wei
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
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10
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Kim SY, Jang MS, Kim J. Impact of Third-Generation Cephalosporin Resistance on Recurrence in Children with Febrile Urinary Tract Infections. J Pers Med 2022; 12:jpm12050773. [PMID: 35629195 PMCID: PMC9144345 DOI: 10.3390/jpm12050773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The purpose of this study was to investigate the association between third-generation cephalosporin resistance and urinary tract infection (UTI) recurrence in patients who underwent voiding cystourethrogram (VCUG). Methods: In this retrospective study, data were obtained from hospitalized pediatric patients who had a first febrile UTI episode and subsequently underwent VCUG. Information based on VCUG was mandatory to identify the presence of vesicoureteral reflux (VUR). A multivariable logistic model was used to identify the risk factors for recurrence. Recurrence was divided into early (90-day) and late (1-year), and sensitivity analyses were performed according to each definition. The estimates of all the statistical models were internally validated using bootstrap samples. Results: A total of 210 patients were included, and the overall recurrence rate of UTI was 26.2% (55 of 210). Third-generation cephalosporin resistance was a significant risk factor for early recurrence (odds ratio: 2.79 [1.08–7.20]) but not for late recurrence. Sensitivity analyses showed that third-generation cephalosporin resistance was a significant risk factor for 60-day recurrence but not for 180-day recurrence. A VUR grade ≥ 3 was identified as a consistent risk factor for both early and late recurrence. Conclusions: Third-generation cephalosporin resistance was a significant risk factor for the early recurrence of pediatric UTI in patients who underwent VCUG.
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Affiliation(s)
| | | | - Jihye Kim
- Correspondence: ; Tel.: +82-10-8894-7219; Fax: +82-482-8334
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11
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Tamas V, Shah S, Hollenbach KA, Kanegaye JT. Emergence of Extended-Spectrum β-Lactamase-Producing Pathogens in Community-Acquired Urinary Tract Infections Among Infants at a Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1053-e1057. [PMID: 35226630 DOI: 10.1097/pec.0000000000002653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing pathogens are common among adults and are associated with extended and multiple hospitalizations. They cause urinary tract infections (UTIs) among children with known risk factors such as urinary tract abnormalities and antimicrobial prophylaxis. The emergence of UTIs caused by ESBL-producing organisms among infants has not been well characterized. OBJECTIVE We sought to describe the incidence and current clinical management of infants who were diagnosed with UTIs caused by ESBL-producing organisms at a pediatric emergency department (ED). In addition, we sought to describe risk factors associated with inpatient hospitalization for UTIs caused by ESBL-producing organisms. METHODS We retrospectively identified infants who were treated in the ED from 2013 to 2017 and who had positive urinalyses and urine cultures positive for greater than 50,000 colony-forming unit per milliliter of a single ESBL-producing urinary pathogen. We abstracted details of clinical management and known previous risk factors, including prior neonatal intensive care unit hospitalization stay, prior UTI caused by an ESBL-producing organism, and known urologic abnormalities. RESULTS Forty-five UTIs caused by ESBL-producing organisms occurred in 43 patients (mean age of 5.9 months and 59% female)-ESBL Escherichia coli represented the majority (42/45). The incidence of UTIs caused by ESBL-producing organisms ranged from 0.9% to 4.5% during the 5-year study period. The 13 patients (26%) admitted from the ED were significantly younger than discharged patients (1.9 vs 6.7 months, P = 0.016) and more likely to have had prior neonatal intensive care unit hospitalizations (50% vs 15.6%, P = 0.0456). Of the 33 visits (77%) resulting in initial outpatient management, 5 were followed by readmission for parenteral antibiotic treatment. Of those who were readmitted, 40% (n = 2) were afebrile at the time of admission. The remainder (28/33) completed outpatient oral antibiotic courses guided by susceptibilities. Two patients (4%) had negative repeat urine cultures despite in vitro resistance to initial antibiotic coverage. CONCLUSIONS Extended spectrum β-lactamase-producing organisms are an increasing cause of UTIs in infants presenting at a pediatric ED, and outpatient management may be reasonable for infants older than 2 months.
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Affiliation(s)
- Vanessa Tamas
- From the Department of Pediatrics, University of California San Diego School of Medicine, La Jolla; and Rady Children's Hospital San Diego, San Diego, CA
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12
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From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections. Antibiotics (Basel) 2022; 11:antibiotics11020201. [PMID: 35203803 PMCID: PMC8868523 DOI: 10.3390/antibiotics11020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case–control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria–resistance pair studied is an important prerequisite to clarify the design of future studies.
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Kim JH, Lee J, Kim DH, Park JY, Lee H, Kang HG, Ahn YH. Maternal antibiotic exposure during pregnancy is a risk factor for community-acquired urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in infants. Pediatr Nephrol 2022; 37:163-170. [PMID: 34170412 DOI: 10.1007/s00467-021-05163-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aimed to investigate the risk factors for community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-positive bacteria in infants. METHODS We retrospectively reviewed the medical records of infants aged < 1 year with first UTI from 2018 to 2019 at two tertiary centers in Korea. Data analyzed included clinical findings, birth history, delivery mode, milk type, use of postpartum care center, and previous use of antibiotics both in the patient and mother. RESULTS Of 265 patients, 62 (23.4%) were diagnosed with first UTI caused by ESBL-positive bacteria at the median age of 3.6 (interquartile range (IQR) 2.3-5.4) months. Maternal use of antibiotics during pregnancy (29.0 vs. 10.3%, p < 0.001) and Klebsiella species (19.4% vs. 4.9%, p < 0.001) were significantly associated with ESBL-positive UTIs and remained valid in the multivariate analysis (odds ratio [OR], 3.40; 95% confidence interval [CI] 1.61-7.19, p = 0.001, and OR 5.26; 95% CI 2.03-13.13, p = 0.001, respectively). Previous antibiotic exposure of patients, previous hospitalization, prematurity, delivery mode, milk type, and use of postpartum care center were not significantly different between ESBL-positive and ESBL-negative groups. With respect to the clinical course of UTI, the ESBL-positive group presented a higher number of blood leukocytes (p = 0.041) and longer hospital stay (p < 0.001) than the ESBL-negative group. CONCLUSIONS About one-fourth of infantile UTI cases were ESBL-positive. Prenatal antibiotic exposure of mothers and Klebsiella species were associated with community-acquired UTI caused by ESBL-positive bacteria.
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Affiliation(s)
- Ji Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea. .,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
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14
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Shaaban OA, Mahmoud NA, Zeidan AA, Kumar N, Finan AC. Prevalence and Resistance Patterns of Pediatric Urinary Tract Infections in Bahrain. Cureus 2021; 13:e20859. [PMID: 35141098 PMCID: PMC8802020 DOI: 10.7759/cureus.20859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/04/2022] Open
Abstract
Background Urinary tract infections (UTI) are a commonly encountered infection in the pediatric age group. Knowledge of the causative pathogens and their antimicrobial resistance patterns in specific geographical locations is important to provide optimum care. The aim of this study is to describe the prevalence and the antimicrobial resistance patterns of the pathogens causing UTI in the pediatric age group in one tertiary inpatient Pediatric unit in Bahrain. Methods This is a retrospective cross-sectional study, conducted at King Hamad University Hospital (KHUH), Bahrain. The inclusion criteria consisted of patients ≤ 14 years of age admitted to the Pediatrics department at KHUH with bacteriologically proven UTI between the months of January 2018 and May 2021. Patients who were identified to have chronic urinary tract conditions or neurodevelopmental problems involving the urinary tract were excluded from the study. Electronic medical records were used to collect data regarding the isolated pathogens and sensitivity testing results. Results A total of 242 cases with positive culture were included. The most common bacteria causing UTI in this sample were successively Escherichia coli (68.60%), Klebsiella pneumoniae (10.30%), Proteus mirabilis (4.69%) and Pseudomonas aeruginosa (3.31%) (p<0.01). E. coli was most resistant to cefazolin (94%), followed by ampicillin (62.68%), whilst it was most sensitive to nitrofurantoin (98.96%) followed by amikacin (98.43%) (p<0.01). K. pneumoniae showed the highest rate of resistance to ampicillin (95.24%) followed by cefazolin (83.33%), meanwhile having the highest sensitivity rate to amikacin (95.24%), followed by ciprofloxacin (90.48%). P. mirabilis had the highest resistance to cefazolin (100%) followed by nitrofurantoin (87.50%), while having the highest sensitivity to piperacillin/tazobactam (100%). Conclusion E. coli is the most common cause of UTI in the pediatric population and it was found to be most sensitive to nitrofurantoin and amikacin whilst being relatively resistant to cefazolin and ampicillin. Similarities between our study and previous studies around the world were found when comparing the antibiotics resistance patterns. Nevertheless, it is our recommendation that empirical antibiotic selection should be tailored to the local data collected from the region.
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Affiliation(s)
- Omaima A Shaaban
- Pediatrics, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, BHR
| | - Nermin A Mahmoud
- Pediatrics, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, BHR
| | - Anas A Zeidan
- Pediatrics, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, BHR
| | - Nitya Kumar
- Epidemiology and Public Health, Royal College of Surgeons in Ireland - Bahrain, Busaiteen, BHR
| | - Alan C Finan
- Pediatrics, King Hamad University Hospital, Busaiteen, BHR
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15
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Esposito S, Biasucci G, Pasini A, Predieri B, Vergine G, Crisafi A, Malaventura C, Casadio L, Sella M, Pierantoni L, Gatti C, Paglialonga L, Sodini C, La Scola C, Bernardi L, Autore G, Canto GD, Argentiero A, Cantatore S, Ceccoli M, De Fanti A, Suppiej A, Lanari M, Principi N, Pession A, Iughetti L. Antibiotic Resistance in Paediatric Febrile Urinary Tract Infections. J Glob Antimicrob Resist 2021; 29:499-506. [PMID: 34801739 DOI: 10.1016/j.jgar.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022] Open
Abstract
Febrile urinary tract infection (UTI) is currently considered the most frequent cause of serious bacterial illness in children in the first 2 years of life. UTI in paediatrics can irreversibly damage the renal parenchyma and lead to chronic renal insufficiency and related problems. To avoid this risk, an early effective antibiotic treatment is essential. Moreover, prompt treatment is mandatory to improve the clinical condition of the patient, prevent bacteraemia, and avoid the risk of bacterial localization in other body sites. However, antibiotic resistance for UTI-related bacterial pathogens continuously increases, making recommendations rapidly outdated and the definition of the best empiric antibiotic therapy more difficult. Variation in pathogen susceptibility to antibiotics is essential for the choice of an effective therapy. Moreover, proper identification of cases at increased risk of difficult-to-treat UTIs can reduce the risk of ineffective therapy. In this review, the problem of emerging antibiotic resistance among pathogens associated with the development of paediatric febrile UTIs and the best potential solutions to ensure the most effective therapy are discussed. Literature analysis showed that the emergence of antibiotic resistance is an unavoidable phenomenon closely correlated with the use of antibiotics themselves. To limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be made. An increased use of antibiotic stewardship can be greatly effective in this regard.
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Affiliation(s)
- Susanna Esposito
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giacomo Biasucci
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Andrea Pasini
- Paediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Barbara Predieri
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonella Crisafi
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Luca Casadio
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, Ravenna, Italy
| | - Marcello Sella
- Pediatric Clinic, Azienda Sanitaria Locale Romagna, Cesena, Italy
| | - Luca Pierantoni
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Claudia Gatti
- Paediatric Surgery, University of Parma, Parma, Italy
| | - Letizia Paglialonga
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Chiara Sodini
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudio La Scola
- Paediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Luca Bernardi
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giovanni Autore
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giulia Dal Canto
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sante Cantatore
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Martina Ceccoli
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Agnese Suppiej
- Paediatric Clinic, University of Ferrara, Ferrara, Italy
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | | | - Andrea Pession
- Paediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Lorenzo Iughetti
- Paediatrics Unit, Maternal-infantile Department, University Hospital, Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
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16
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Esposito S, Maglietta G, Di Costanzo M, Ceccoli M, Vergine G, La Scola C, Malaventura C, Falcioni A, Iacono A, Crisafi A, Iughetti L, Conte ML, Pierantoni L, Gatti C, Caminiti C, Biasucci G. Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy. Antibiotics (Basel) 2021; 10:antibiotics10101207. [PMID: 34680787 PMCID: PMC8532648 DOI: 10.3390/antibiotics10101207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between 1 January 2012, and 30 June 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-903524
| | - Giuseppe Maglietta
- Research and Innovation Unit, University Hospital, 43126 Parma, Italy; (G.M.); (C.C.)
| | - Margherita Di Costanzo
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy; (M.D.C.); (G.B.)
| | - Martina Ceccoli
- Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (M.C.); (L.I.)
| | - Gianluca Vergine
- Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy; (G.V.); (M.L.C.)
| | - Claudio La Scola
- Paediatric Clinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | | | - Alice Falcioni
- Paediatric Unit, Forlì Hospital, AUSL Romagna, 47121 Forlì, Italy;
| | - Alessandra Iacono
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy;
| | - Antonella Crisafi
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Lorenzo Iughetti
- Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (M.C.); (L.I.)
| | - Maria Luisa Conte
- Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy; (G.V.); (M.L.C.)
| | - Luca Pierantoni
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Claudia Gatti
- Paediatric Surgery, University Hospital, 43126 Parma, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital, 43126 Parma, Italy; (G.M.); (C.C.)
| | - Giacomo Biasucci
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy; (M.D.C.); (G.B.)
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Romandini A, Pani A, Schenardi PA, Pattarino GAC, De Giacomo C, Scaglione F. Antibiotic Resistance in Pediatric Infections: Global Emerging Threats, Predicting the Near Future. Antibiotics (Basel) 2021; 10:antibiotics10040393. [PMID: 33917430 PMCID: PMC8067449 DOI: 10.3390/antibiotics10040393] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antibiotic resistance is a public health threat of the utmost importance, especially when it comes to children: according to WHO data, infections caused by multidrug resistant bacteria produce 700,000 deaths across all ages, of which around 200,000 are newborns. This surging issue has multipronged roots that are specific to the pediatric age. For instance, the problematic overuse and misuse of antibiotics (for wrong diagnoses and indications, or at wrong dosage) is also fueled by the lack of pediatric-specific data and trials. The ever-evolving nature of this age group also poses another issue: the partly age-dependent changes of a developing system of cytochromes determine a rather diverse population in terms of biochemical characteristics and pharmacokinetics profiles, hard to easily codify in an age- or weight-dependent dosage. The pediatric population is also penalized by the contraindications of tetracyclines and fluoroquinolones, and by congenital malformations which often require repeated hospitalizations and pharmacological and surgical treatments from a very young age. Emerging threats for the pediatric age are MRSA, VRSA, ESBL-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and the alarming colistin resistance. Urgent actions need to be taken in order to step back from a now likely post-antibiotic era, where simple infections might cause infant death once again.
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Affiliation(s)
- Alessandra Romandini
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122 Milan, Italy; (A.R.); (P.A.S.)
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (F.S.)
| | - Paolo Andrea Schenardi
- Department of Oncology and Hemato-Oncology, Postgraduate School of Clinical Pharmacology and Toxicology, Università degli Studi di Milano, 20122 Milan, Italy; (A.R.); (P.A.S.)
| | | | - Costantino De Giacomo
- Maternal and Infantile Department of Pediatrics, ASST Grande Ospedale Metropolitano Niguarda, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-02-6444-2432
| | - Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy; (A.P.); (F.S.)
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Camacho-Cruz J, Martinez JM, Cufino JM, Moreno GC, Murillo CR, Suarez Fuentes MA, Castro CA. Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Causing Community-Acquired Urinary Tract Infections in Children in Colombia. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2131-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Kitaoka H, Inatomi J, Chikai H, Watanabe K, Kumagai T, Masui A, Shimizu N. Renal abscess with bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli: a case report. BMC Pediatr 2020; 20:461. [PMID: 33023518 PMCID: PMC7541294 DOI: 10.1186/s12887-020-02366-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Renal abscess in children is a rare and severe form of infectious kidney disease that is responsible for several serious complications. In this report, we describe a previously healthy 5-year-old girl with a renal abscess caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli), which led to bacteremia and renal scarring. Case presentation The patient presented to our department with high fever, headache, vomiting for 2 days and high inflammatory response. We diagnosed her with a urinary tract infection and initiated treatment with ampicillin and cefotaxime. Gram-negative bacilli bacteremia was noted on day 3. On day 4, her fever persisted, and a computed tomography (CT) scan revealed a renal abscess in the left kidney. After identifying the bacteria as ESBL-producing E. coli from the blood culture, we switched to the antibiotic meropenem and continued treatment for 3 weeks. The renal abscess was not drained. Although the renal abscess was successfully treated and it disappeared, a low-density area remained in same lesion on subsequent CT scans and a dimercaptosuccinic acid renal scan performed 4 months after onset revealed renal scarring. Conclusion Given the increasing prevalence of ESBL-producing microorganisms, clinicians should be aware of the possibility of renal abscesses caused by community-acquired ESBL-producing organisms even in previously healthy children. Once a renal abscess is suspected, early diagnosis and management are important for reducing the risk of life-threating complications and renal scarring.
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Affiliation(s)
- Hiroki Kitaoka
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan.
| | - Jun Inatomi
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan.,Department of Pediatrics, Teikyo University Mizonokuchi Hospital, Kawasaki-shi, Kanagawa, Japan
| | - Hayato Chikai
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan
| | - Keiko Watanabe
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan
| | - Tadayuki Kumagai
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan
| | - Ayako Masui
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan
| | - Nobutaka Shimizu
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, 425-8505, Shizuoka, Japan
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20
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Multidrug-resistant organisms in urinary tract infections in children. Pediatr Nephrol 2020; 35:1563-1573. [PMID: 31418063 DOI: 10.1007/s00467-019-04316-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/10/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
The global spread of multidrug-resistant organisms has led to an increase in urinary tract infections (UTIs) in children that are difficult to treat. This review explores the current literature regarding multidrug-resistant UTIs in childhood and proposes an approach to management. Multidrug-resistant organisms include a wide range of potential urinary tract pathogens and, while most literature on drug resistance in UTIs during childhood has focused on extended-spectrum beta-lactamase producing organisms, in this review, we have included a discussion of multidrug resistance including and beyond beta-lactamase production. We provide definitions for multidrug-resistant organisms in line with current consensus guidelines and summarise clinically relevant mechanisms of resistance. Additionally, in this review, we outline the global epidemiology of multidrug-resistant UTIs in children, summarising published prevalence rates, which range from 5 to 90% in different settings. Finally, we also critically review the evidence on risk factors for colonisation and infection of the urinary tract with multidrug-resistant organisms, including prior antibiotic use, hospitalisation and underlying urological malformations. We also highlight multidrug-resistant UTI occurring in children without any identifiable risk factors, reflecting an increasing prevalence of colonisation with these organisms in the general community. Taken as a whole, this emphasises a need for careful and evidence-based use of antibiotics when treating UTIs in children and, to aide clinicians, we have outlined here potential management strategies for when infection with a multidrug-resistant organism is suspected or confirmed.
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Trends in Antimicrobial Susceptibility of Escherichia coli Isolates in a Taiwanese Child Cohort with Urinary Tract Infections between 2004 and 2018. Antibiotics (Basel) 2020; 9:antibiotics9080501. [PMID: 32785113 PMCID: PMC7460002 DOI: 10.3390/antibiotics9080501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to investigate the annual incidence of Escherichia coli isolates in urinary tract infections (UTIs) and the antimicrobial resistance of the third-generation cephalosporin (3GCs) to E. coli, including the factors associated with the resistance in hospitalized children in Taiwan. A large electronic database of medical records combining hospital admission and microbiological data during 2004–2018 was used to study childhood UTIs in Taiwan. Annual incidence rate ratios (IRR) of E. coli in children with UTIs and its resistant rate to the 3GCs and other antibiotics were estimated by linear Poisson regression. Factors associated with E. coli resistance to 3GCs were assessed through multivariable logistic regression analysis. E. coli UTIs occurred in 10,756 unique individuals among 41,879 hospitalized children, with 92.58% being community associated based on urine culture results reported within four days after the hospitalization. The overall IRR E. coli UTI was 1.01 (95% confidence interval (CI) 0.99–1.02) in community-associated (CA) and 0.96 (0.90–1.02) in healthcare-associated infections. The trend in 3GCs against E. coli increased (IRR 1.18, 95% CI 1.13–1.24) over time in CA-UTIs. Complex chronic disease (adjusted odds ratio (aOR), 2.04; 95% CI, 1.47–2.83) and antibiotics therapy ≤ 3 months prior (aOR, 1.49; 95% CI, 1.15–1.94) were associated with increased risk of 3GCs resistance to E. coli. The study results suggested little or no change in the trend of E. coli UTIs in Taiwanese youths over the past 15 years. Nevertheless, the increase in 3GCs-resistant E. coli was substantial. Interventions for children with complex chronic comorbidities and prior antibiotic treatment could be effective in reducing the incidence of 3GCs-resistant E. coli in CA-UTIs in this region and more generally.
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22
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Fostira E, Bitsori M, Vergadi E, Maraki S, Galanakis E. Short-term antibiotic exposure affected the type and resistance of uropathogens similar to long-term antibiotic prophylaxis in children hospitalised for urinary tract infections. Acta Paediatr 2020; 109:1260-1266. [PMID: 31746494 DOI: 10.1111/apa.15099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/21/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
AIM We investigated the impact of any antibiotic exposure on unusual and resistant pathogens in children with a urinary tract infection (UTI). METHODS This was a retrospective cohort study of 695 children (54% female) hospitalised with 711 UTI episodes at Heraklion University Hospital, Greece, from January 2007 to December 2017. Three groups were studied: no previous antibiotic exposure, ongoing prophylaxis and short-term exposure to antibiotics in the last six months. RESULTS The median age at hospitalisation was 0.8 years (range 25 days to 15.9 years). Previous short-term exposure and prophylaxis were important determinants of non-Escherichia coli (E. coli) (OR 2.05, 95% CI 1.25-3.36, P = .0017 and OR 3.84, 95% CI 2.32-6.34, P < .0001, respectively) and extended-spectrum beta-lactamase-positive uropathogens (OR 2.43, 95% CI 1.36-4.32, P = .0025 and OR 2.63, 95% CI 1.31-5.33, P = .0070, respectively). Short-term antibiotics in the last 30 days or intravenous antibiotics were mostly associated with non-E. coli pathogens (OR 6.71 and OR 2.55, respectively). The most important determinants of E. coli resistance were short-term antibiotics for ampicillin (OR 2.58) and prophylaxis for cotrimoxazole (OR 2.64). CONCLUSION Recent short-term exposure to antibiotics and ongoing prophylaxis both had a significant impact on the type and resistance of uropathogens.
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Affiliation(s)
- Ekaterini Fostira
- Department of Paediatrics Heraklion University Hospital Heraklion Greece
| | - Maria Bitsori
- Department of Paediatrics Heraklion University Hospital Heraklion Greece
| | - Eleni Vergadi
- Department of Paediatrics Heraklion University Hospital Heraklion Greece
| | - Sofia Maraki
- Department of Clinical Microbiology Heraklion University Hospital Heraklion Greece
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23
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Urinary Tract Infections With Extended-spectrum-β-lactamase-producing Bacteria: Case-control Study. Pediatr Infect Dis J 2020; 39:211-216. [PMID: 32032306 DOI: 10.1097/inf.0000000000002531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are the most common bacterial infections among infants and young children with fever without a source. Extended-spectrum β-lactamases (ESBLs) have emerged as emerging cause of UTI globally; however, data about risk factors and clinical features of children with ESBL-UTI have been scarce. OBJECTIVE To describe the predisposing risk factors, clinical and microbiologic features associated with pediatric UTIs caused by ESBL-producing bacteria (ESBL-PB). METHODS Our nested case-control study ran from January 1, 2012 to December 31, 2016. Pediatric patients with ESBL-PB UTI were compared with patients with non-ESBL-PB UTI matched for age and year of diagnosis. RESULTS A total of 720 children were enrolled (240 cases and 480 controls). Patients with ESBL-PB UTI were more likely to have a history of prior intensive care unit (ICU) admission (22.5% vs. 12.3%, P < 0.001), at least one underlying comorbidity (19.2% vs. 5.8%, P < 0.001), prior hospitalization (47.1% vs. 32.9%, P < 0.001), exposure to a cephalosporin antibiotic within 30 days before culture (7.5% vs. 4.2%, P = 0.035), and to have cystostomy (7.9% vs. 1.5%, P < 0.001) compared with those with non-ESBL-PB UTI. Patients with ESBL-PB UTI were more likely to present with hypothermia (48.8% vs. 38.5%, P = 0.009); had significantly longer average hospital stays {8.7 days [95% confidence interval (CI): 3.2-14.3] vs. 4.0 days (95% CI: 2.5-5.5)} and were more likely to be admitted to the ICU [odds ratio (OR) 1.8; 95% CI: 1.1-2.9). Multivariate analysis determined that only having cystostomy (OR 3.7; 95% CI: 1.4-9.4] and at least one underlying comorbidity (OR 2.4; 95% CI: 1.3-4.3) were the independent risk factors for ESBL-PB UTI. All ESBL-PB isolates tested against meropenem were susceptible, majority were resistant to multiple non-beta-lactam antibiotics. CONCLUSIONS Children with underlying comorbidities and cystostomy are at higher risk for ESBL-PB UTI, but majority of ESBL cases were patients without any known risk factors. Clinical signs/symptoms and commonly used biochemical markers were unreliable to differentiate cases caused by ESBL-PB from those caused by non-ESBL-PB. Further research is needed to elucidate the conditions most associated with ESBL-PB UTIs among children to properly guide empirical therapy in patients at-risk for these infections, to improve the outcomes, and finally, to determine strategies for rational antimicrobial use.
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Alves J, Dias L, Mateus J, Marques J, Graças D, Ramos R, Seldin L, Henriques I, Silva A, Folador A. Resistome in Lake Bolonha, Brazilian Amazon: Identification of Genes Related to Resistance to Broad-Spectrum Antibiotics. Front Microbiol 2020; 11:67. [PMID: 32117110 PMCID: PMC7010645 DOI: 10.3389/fmicb.2020.00067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 01/14/2020] [Indexed: 01/02/2023] Open
Abstract
Resistance to antibiotics is one of the most relevant public health concerns in the world. Aquatic environments play an important role because they are reservoirs for antibiotic resistance genes and antibiotic-resistant strains, contributing to the spread of resistance. The present study investigated the resistome in Lake Bolonha (three sampling sites) in the Amazon region using a metagenomics approach and culture-dependent methods. Whole-metagenome-based results showed that the most abundant phyla were Protobacteria, Actinobacteria, Firmicutes, Bacteroidetes and Cyanobacteria. The composition of the resistome demonstrated that the genes that confer resistance to β-lactams were prevalent at all sampling sites, followed by genes conferring resistance to aminoglycosides and tetracycline. Acquired genes encoding extended-spectrum β-lactamases (e.g., blaCTX–M) and resistance to carbapenems (e.g., blaIMP and blaVIM) were detected through metagenome analysis. Bacteria were isolated from culture medium supplemented with cefotaxime or imipenem, and isolates were identified and analyzed for their antibiotic susceptibility profiles and resistance genes. In total, 98 bacterial isolates belonging to the genera Pseudomonas (37), Acinetobacter (32), Klebsiella (13), Enterobacter (9), Pantoe (3), Stenotrophomonas (3), and Methylobacterium (1) were obtained. Among isolates, the most abundant genes were blaCTX–M (28.3%), blaSHV (22.6%) and blaTEM (18.8%) in isolates from cefotaxime-supplemented medium and blaVIM (28.8%) and blaIMP (22.2%) in isolates recovered from imipenem-supplemented medium. The genes intl1 and intl2 were detected in 19.3% and 7.1% of isolates. Antibiograms showed that 94.9% (from cefotaxime-supplemented medium) and 85.7% (from imipenem-supplemented medium) of the isolates were multidrug resistant. Besides cefotaxime and imipenem, isolates were mostly resistant to aztreonam (91.8%), amoxicillin (98.8%), ampicillin (82.6%), and nalidixic acid (77.5%). Hence, the present study demonstrates that Lake Bolonha is a reservoir of bacteria resistant to antibiotics and resistance genes, some of which are of critical importance to human health.
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Affiliation(s)
- Jorianne Alves
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
| | - Larissa Dias
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
| | - Jackeline Mateus
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joana Marques
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
| | - Diego Graças
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
| | - Rommel Ramos
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
| | - Lucy Seldin
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabel Henriques
- Center for Environmental and Marine Studies (CESAM), University of Aveiro, Aveiro, Portugal.,Department of Life Sciences, Faculty of Science and Technology, University of Coimbra, Coimbra, Portugal
| | - Artur Silva
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
| | - Adriana Folador
- Laboratório de Genômica e Bioinformática, Centro De Genômica e Biologia de Sistemas, Universidade Federal Do Pará, Belém, Brazil
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Clinical Features of Febrile Urinary Tract Infection Caused by Extended-spectrum Beta-lactamase-producing Escherichia Coli in Children. Keio J Med 2020; 69:43-47. [DOI: 10.2302/kjm.2019-0005-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Hyun HS, Kim JH, Cho MH, Park E, Ha IS, Cheong HI, Kang HG. Low relapse rate of urinary tract infections from extended-spectrum beta-lactamase-producing bacteria in young children. Pediatr Nephrol 2019; 34:2399-2407. [PMID: 31270617 DOI: 10.1007/s00467-019-04298-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/30/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Extended-spectrum-beta-lactamase (ESBL)-producing bacteria are an increasingly important cause of urinary tract infections (UTIs) worldwide. We evaluated clinical characteristics and associated risk factors of UTIs in young children according to ESBL-producing status and relapse rates. METHODS All urinary culture results in patients younger than 2 years old were assessed, and only children with febrile UTIs from gram-negative bacterial infections were reviewed. RESULTS Of 845 episodes evaluated, 146 (17.3%) were caused by ESBL-positive bacteria. Significant differences were observed in previous UTIs, use of antibiotics or history of hospitalization within previous 3 months, and underlying urinary abnormalities between the ESBL UTI and non-ESBL UTI groups. After 2 weeks of treatment completion, UTI relapse occurred in 2.7% of children in the ESBL group and 1.1% of children in the non-ESBL group (P = 0.13). In the ESBL UTI group, relapse rate was not significantly different between patients treated with susceptible antibiotics and those treated with non-susceptible but clinically effective antibiotics. CONCLUSIONS Previous history of UTI, antibiotic treatment, or hospitalization within previous 3 months and underlying disease are risk factors for ESBL UTI in children under 24 months of age. However, relapse rate was < 3% regardless of in vitro susceptibility of the treating antibiotics, as long as the antibiotics were clinically effective. We cautiously propose that we may continue the use of initial empirical antibiotics when a definite clinical response is observed, although further study is necessary to confirm the findings of this study.
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Affiliation(s)
- Hye Sun Hyun
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Kim
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Myung Hyun Cho
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eujin Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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27
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Albaramki JH, Abdelghani T, Dalaeen A, Khdair Ahmad F, Alassaf A, Odeh R, Akl K. Urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and antibiotic resistance. Pediatr Int 2019; 61:1127-1132. [PMID: 31206219 DOI: 10.1111/ped.13911] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate the risk factors for acquisition of extended spectrum β-lactamase (ESBL)-producing bacteria in community-acquired urinary tract infection (UTI) and to evaluate their antimicrobial resistance. METHODS The medical records of hospitalized children were retrospectively evaluated. Children with ESBL-producing bacteria UTI were matched with controls with non-ESBL-producing bacteria UTI of the same age and gender. RESULTS A total of 243 patients with community-acquired UTI in a 5 year period were evaluated, of whom 46% had UTI caused by ESBL bacteria. Seventy-seven cases were matched with 77 controls. There were no significant differences in the clinical presentation between the two groups apart from a longer hospital stay in the ESBL group (9.1 ± 5.5 days vs 8.0 ± 4.4 days, P = 0.013). Significant potential risk factors for ESBL-UTI were previous use of antibiotics in the last 3 months, previous hospitalization in the last 3 months, history of recurrent UTI, and presence of renal anomalies. On logistic regression analysis, history of previous hospitalization in the last 3 months (OR, 3.83; 95%CI: 1.49-9.84) was identified as an independent significant risk factor for ESBL-UTI. There was a significantly higher resistance to amoxicillin-clavulanate, amikacin, gentamycin and quinolones in the ESBL group compared with the control group. CONCLUSION Recognizing the risk factors for ESBL-UTI helps to identify the high-risk cases and enables proper management.
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Affiliation(s)
- Jumana H Albaramki
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Tariq Abdelghani
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Alaa Dalaeen
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Fareed Khdair Ahmad
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Abeer Alassaf
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Kamal Akl
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
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28
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Zhu FH, Rodado MP, Asmar BI, Salimnia H, Thomas R, Abdel-Haq N. Risk factors for community acquired urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli in children: a case control study. Infect Dis (Lond) 2019; 51:802-809. [PMID: 31429616 DOI: 10.1080/23744235.2019.1654127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: We noted a recent increase in cases of urinary tract infection due to community-acquired ESBL-producing Escherichia coli in children treated at our institution. Risk factors of urinary tract infection due to ESBL-producing E. coli in children in the USA remain unclear. Methods: A single center retrospective case control study of UTI due to CA-ESBL-producing E. coli during a 5-year period (2012-2016). Control cases with non-ESBL-producing E. coli urinary tract infection were matched by age, gender and year of infection. Results: A total of 111 patients with ESBL-producing E coli urinary tract infection and 103 controls were included. The proportion of ESBL-producing E coli urinary tract infection ranged from 7% to 15% of all UTI cases. The distribution of ESBL cases per year: 27 in 2012; 18 in 2013; 22 in 2014; 15 in 2015 and 29 in 2016. Median age was 4 years with female predominance (84%). The ESBL group was predominantly African American (32%) followed by individuals of Middle Eastern ethnic background (31%). Risk factors by univariate analysis were vesicoureteral reflux: (20.9 ESBL group vs 6% controls; p = .002), prior antibiotic usage in the last 3 months (including β-lactams), prior UTI (last 3 months), recent hospitalization (last 3 months) and Middle Eastern ethnic background. However, multivariate analysis showed that only prior antibiotic usage (p = .001) and Middle Eastern ethnic background (p < .001) were independent risk factors. ESBL-producing strains were more frequently resistant to trimethoprim-sulfamethoxazole (72% vs 25%) and ciprofloxacin (73% vs 5%) than strains not producing ESBL. Conclusion: Risk factors for community-acquired ESBL-producing E coli urinary tract in our pediatric patient population were antibiotic usage within the previous 3 months and Middle Eastern ethnic background. This may be related to increased risk of intestinal colonization with resistant bacterial strains.
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Affiliation(s)
- Frank H Zhu
- Division of Infectious Diseases, Children's Hospital of Michigan , Detroit , MI , USA
| | - Maria P Rodado
- Division of Infectious Diseases, Children's Hospital of Michigan , Detroit , MI , USA
| | - Basim I Asmar
- Division of Infectious Diseases, Children's Hospital of Michigan , Detroit , MI , USA.,Carman and Ann Adams Department of Pediatrics, Wayne State University , Detroit , MI , USA
| | - Hossein Salimnia
- Department of Pathology, Wayne State University , Detroit , MI , USA.,Detroit Medical Center University Laboratories , Detroit , MI , USA
| | - Ronald Thomas
- Carman and Ann Adams Department of Pediatrics, Wayne State University , Detroit , MI , USA
| | - Nahed Abdel-Haq
- Division of Infectious Diseases, Children's Hospital of Michigan , Detroit , MI , USA.,Carman and Ann Adams Department of Pediatrics, Wayne State University , Detroit , MI , USA
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29
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Kara A, Gurgoze MK. The use of nitrofurantoin for children with acute cystitis caused by extended-spectrum Β-lactamase-producing Escherichia coli. J Pediatr Urol 2019; 15:378.e1-378.e5. [PMID: 31014984 DOI: 10.1016/j.jpurol.2019.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute cystitis in children caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) is on the rise. Treatment of these is usually parenteral treatment. The aim of this study was to investigate the clinical and microbiological efficacy of oral nitrofurantoin treatment in children with lower urinary tract infection (UTI) caused by ESBL-producing E. coli. METHODS Fifty children with lower UTI due to ESBL-producing E. coli were prospectively studied. Demographic data, clinical condition, laboratory values, treatment regimens, and complications of the patients were recorded. Urine samples were obtained by transurethral catheterization or clean catch; urine bags were not used for specimen collection for culture. Patients with lower UTI due to ESBL-producing E. coli and found to be susceptible to nitrofurantoin were given oral nitrofurantoin. Patients were re-evaluated 3-4 days after the end of treatment. Renal scintigraphy was performed 1-3 months after the end of treatment. RESULTS A total of 50 pediatric patients (48 females and 2 males) were enrolled into study. The mean age was 7.5 ± 3.96 years (range, 1-17 years). The duration of nitrofurantoin treatment was 10 days. Bacteriological response was observed in 49 of 50 patients (98%). No patient had symptoms after treatment. No significant side-effect was observed in any of the patients. All patients had normal serum creatinine values. Renal scintigraphic study, which was performed in all patients 1-3 months after completion of treatment, demonstrated the non-scarring in 48 of 50 patients (96%). CONCLUSIONS UTIs due to ESBL-producing E. coli are a serious problem because of the bacteria's multidrug antibiotic resistance pattern. This study suggests that oral nitrofurantoin treatment could be a good alternative for lower UTI caused by ESBL-producing E. coli in pediatric patients.
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Affiliation(s)
- A Kara
- Department of Pediatric Nephrology, Firat University School of Medicine, 23119, Elazig, Turkey.
| | - M K Gurgoze
- Department of Pediatric Nephrology, Firat University School of Medicine, 23119, Elazig, Turkey.
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Hu YJ, Ogyu A, Cowling BJ, Fukuda K, Pang HH. Available evidence of antibiotic resistance from extended-spectrum β-lactamase-producing Enterobacteriaceae in paediatric patients in 20 countries: a systematic review and meta-analysis. Bull World Health Organ 2019; 97:486-501B. [PMID: 31258218 PMCID: PMC6593334 DOI: 10.2471/blt.18.225698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To make a systematic review of risk factors, outcomes and prevalence of extended-spectrum β-lactamase-associated infection in children and young adults in South-East Asia and the Western Pacific. METHODS Up to June 2018 we searched online databases for published studies of infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in individuals aged 0-21 years. We included case-control, cohort, cross-sectional and observational studies reporting patients positive and negative for these organisms. For the meta-analysis we used random-effects modelling of risk factors and outcomes for infection, and meta-regression for analysis of subgroups. We mapped the prevalence of these infections in 20 countries and areas using available surveillance data. FINDINGS Of 6665 articles scanned, we included 40 studies from 11 countries and areas in the meta-analysis. The pooled studies included 2411 samples testing positive and 2874 negative. A higher risk of infection with extended-spectrum β-lactamase-producing bacteria was associated with previous hospital care, notably intensive care unit stays (pooled odds ratio, OR: 6.5; 95% confidence interval, CI: 3.04 to 13.73); antibiotic exposure (OR: 4.8; 95% CI: 2.25 to 10.27); and certain co-existing conditions. Empirical antibiotic therapy was protective against infection (OR: 0.29; 95% CI: 0.11 to 0.79). Infected patients had longer hospital stays (26 days; 95% CI: 12.81 to 38.89) and higher risk of death (OR: 3.2; 95% CI: 1.82 to 5.80). The population prevalence of infection was high in these regions and surveillance data for children were scarce. CONCLUSION Antibiotic stewardship policies to prevent infection and encourage appropriate treatment are needed in South-East Asia and the Western Pacific.
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Affiliation(s)
- Yanhong Jessika Hu
- School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Anju Ogyu
- School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Keiji Fukuda
- School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Herbert H Pang
- School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
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Będzichowska A, Przekora J, Stapińska-Syniec A, Guzek A, Murawski P, Jobs K, Wróblewska B, Kalicki B. Frequency of infections caused by ESBL-producing bacteria in a pediatric ward - single-center five-year observation. Arch Med Sci 2019; 15:688-693. [PMID: 31110535 PMCID: PMC6524197 DOI: 10.5114/aoms.2017.72407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Infections caused by Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) are a serious therapeutic and clinical problem. An increasing role of ESBL(+) pathogens is observed in both community- and hospital-acquired infections. The aim of the study was to assess the incidence and the risk factors for ESBL(+) bacteria infection in a pediatric ward during a 5-year period. MATERIAL AND METHODS The medical documentation data of patients hospitalized in the Department of Pediatrics, Pediatric Nephrology and Allergology between 2011 and 2015 were subjected to a retrospective analysis. Cases of ESBL(+) bacterial infections were analyzed in detail. RESULTS 0.57% (46) of all the hospitalizations (8015) during the 5-year observation period in our department were caused by ESBL (+) pathogens. It constituted 8.5% of all positive microbiological cultures obtained. The analysis revealed an increasing trend in the number of ESBL (+) infections throughout the observed period. 43.5% of patients were only asymptomatic carriers. In 71.7% urinary tract structural and functional abnormalities were present. 76.1% of patients had been hospitalized previously and 60.9% had undergone urinary tract invasive procedures. CONCLUSIONS The results confirm the rising trend of ESBL (+) infections during the observed period. ESBL (+) bacteria were isolated primarily in previously hospitalized children with particular reference to urinary tract invasive procedures during hospitalizations. Moreover, the study showed that patients with urogenital disorders and non-urinary chronic diseases are more susceptible to these priority pathogen infections.
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Affiliation(s)
- Agata Będzichowska
- Department of Pediatrics, Pediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Jędrzej Przekora
- Department of Pediatrics, Pediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Angelika Stapińska-Syniec
- Students’ Academic Club at the Department of Pediatrics, Pediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Aneta Guzek
- Department of Medical Diagnostics, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Murawski
- Information and Communication Technology Department, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Pediatrics, Pediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Barbara Wróblewska
- Department of Immunology and Food Microbiology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Olsztyn, Poland
| | - Bolesław Kalicki
- Department of Pediatrics, Pediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
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Kang KT, Ng K, Kendrick J, Tilley P, Ting J, Rassekh S, Murthy S, Roberts A. Third-generation cephalosporin-resistant urinary tract infections in children presenting to the paediatric emergency department. Paediatr Child Health 2019; 25:166-172. [PMID: 32296278 DOI: 10.1093/pch/pxy175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/20/2018] [Indexed: 11/15/2022] Open
Abstract
Background The incidence of antibiotic-resistant urinary tract infections (UTIs) in children is increasing. The purpose of this study was to describe the incidence, clinical characteristics, and risk factors for third-generation cephalosporin-resistant UTIs presenting to the paediatric emergency department (ED). Methods This was a retrospective cohort study conducted at British Columbia Children's Hospital. Children aged 0 to 18 years old presenting to the ED between July 1, 2013 and June 30, 2014 and were found to have UTI due to Enterobacteriaceae and Pseudomonas species were included. Patient demographics, clinical features, laboratory findings, and outcomes were compared using standard statistical analyses. Risk factors for resistant UTIs were analyzed using multiple logistic regression analysis. Results There were 294 eligible patients. The median age was 27.4 months. A third-generation cephalosporin-resistant organism was identified in 36 patients (12%). Patients with resistant UTI had lower rates of appropriate empiric antibiotic therapy (25% versus 95.3%, P<0.05), higher rates of hospitalization (38.9% versus 21.3%, P<0.05), higher rates of undergoing a voiding cystourethrogram (19.4% versus 5.0%, P<0.05), and higher rates of UTI recurrence within 30 days (13.9% versus 4.7%, P<0.05). In multivariate analysis, recent hospitalization (odds ratio [OR] 4.3, confidence interval [CI] 1.2 to 16) and antibiotic therapy (OR 3.5, CI 1.5 to 8.5) within the previous 30 days were risk factors for resistant UTI. Conclusions Third-generation cephalosporin-resistant organisms account for a significant proportion of community-acquired paediatric UTIs. Recent hospitalization and antibiotic use are associated with increased risk of resistant UTI.
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Affiliation(s)
- Kristopher T Kang
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Karen Ng
- Department of Pharmacy, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Jennifer Kendrick
- Department of Pharmacy, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Peter Tilley
- Department of Pathology and Laboratory Medicine, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Joseph Ting
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Shahrad Rassekh
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia
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Youssef MM, Rizk HA, Hassuna NA. Phenotypic and Genotypic Characterization of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Asymptomatic Bacteriuria in Pregnancy. Microb Drug Resist 2019; 25:731-738. [PMID: 30676863 DOI: 10.1089/mdr.2018.0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Asymptomatic bacteriuria (ASB) has been consistently observed in pregnancy. However, there is a paucity of data on the prevalence and characteristics of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in ASB in pregnant women. Therefore, we sought to investigate ESBL-producing and multidrug-resistant Enterobacteriaceae in antenatal women with ASB. Urine samples were collected from 310 asymptomatic pregnant women attending primary antenatal clinics and screened for significant bacteriuria. Isolates of Enterobacteriaceae were phenotypically tested for their ESBL production. ESBL genes (CTX-M, TEM, and SHV genes) were then amplified by polymerase chain reaction (PCR). Multiplex PCRs were used to perform phylogenetic typing of ESBL-producing Escherichia coli isolates and to examine the commonality of sequence type 131 (ST131)-O25b and ST131-O16. A total of 103 (33.2%) pregnant women were positive for significant bacteriuria (80 Enterobacteriaceae). Of these isolates, 32.5% (n = 26) were ESBL producers and had a higher rate of multidrug resistance than non-ESBL producers. Genotypic characterization of ESBL-producing isolates showed that 84.6% had the blaCTX-M gene (blaCTX-M-15 = 77.3%; blaCTX-M-9 = 18.2%). None of the isolates were of the TEM or SHV type. Half of the ESBL-producing E. coli isolates were of the phylogroup B2, and 4 (20%) isolates were of the ST131-O16 clonal subgroup. This study is the first in Egypt to provide evidence for the high prevalence of ESBL-producing Enterobacteriaceae in pregnant women with ASB. It also represents an important step toward genotypic characterization of this resistant form of bacteria, which may be useful for future antimicrobial studies.
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Affiliation(s)
- Mariam M Youssef
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Hazim A Rizk
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Noha A Hassuna
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
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Jayaweera JAAS, Reyes M. Antimicrobial misuse in pediatric urinary tract infections: recurrences and renal scarring. Ann Clin Microbiol Antimicrob 2018; 17:27. [PMID: 29940982 PMCID: PMC6016131 DOI: 10.1186/s12941-018-0279-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background In children, urinary tract infection (UTI) is one of a common bacterial infection. This study was conducted to detect the uropathogen, antimicrobial susceptibility, pathogen associated with recurrences and renal scarring in children initially taken care from general practitioners and later presented to tertiary care. Methods Every inward UTI episode, culture and antimicrobial susceptibility was done while on past 6-month, history of infections and use of antimicrobials was collected using clinical records and demonstration of antimicrobials. Children with recurrent pyelonephritis was followed and in vitro bio film formation was assessed. Results Frequency of UTI was significantly high among infants (p = 0.03). Last 6-month, all (220) were exposed to antimicrobials. Cefixime was the commonly prescribed antimicrobial (p = 0.02). In current UTI episode, 64.5% (142/220) of children with UTI were consulted GPs’ prior to seek treatment from tertiary care pediatric unit (p = 0.02). While on follow up child who developed UTI, found urine culture isolates were significantly shifted from E. coli and K. pneumoniae to extended spectrum of beta-lactamase (ESBL) E. coli and K. pneumoniae. Out of 208 participants, 36 of them had re-current pyelonephritis (R-PN). Renal scarring (RS) was detected in 22 out of 70 patients with pyelonephritis following dimercaptosuccinic acid scan. Following each episodes of recurrent pyelonephritis 11% of new scar formation was detected (p = 0.02). Bio film forming E. coli and K. pneumoniae was significantly associated in patients with R-PN (p = 0.04). Discussion Medical care providers often prescribe antimicrobials without having an etiological diagnosis. While continuing exposure of third generation cephalosporin and carbapenem leads to development of ESBL and CRE microbes in great. The empiric uses of antimicrobials need to be stream lined with local epidemiology and antimicrobial susceptibility pattern. R-PN in childhood leads to RS. In great, bio film formation act as the focus for such recurrences.
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Affiliation(s)
| | - Mohommed Reyes
- Department of Pediactrics, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
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Clinical patterns, epidemiology and risk factors of community-acquired urinary tract infection caused by extended-spectrum beta-lactamase producers: a prospective hospital case-control study. Infection 2018; 46:495-501. [DOI: 10.1007/s15010-018-1148-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/05/2018] [Indexed: 10/16/2022]
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Extended-spectrum β-lactamase-producing Enterobacteriaceae, national study of antimicrobial treatment for pediatric urinary tract infection. Med Mal Infect 2018; 48:193-201. [DOI: 10.1016/j.medmal.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/22/2017] [Accepted: 01/11/2018] [Indexed: 11/23/2022]
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Beetz R. Pyelonephritis und Urosepsis. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Community-onset carbapenem-resistant Klebsiella pneumoniae urinary tract infections in infancy following NICU hospitalisation. J Pediatr Urol 2017; 13:495.e1-495.e6. [PMID: 28341427 DOI: 10.1016/j.jpurol.2017.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/05/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Urinary tract infection (UTI) is a common bacterial infection in childhood with favourable outcome. However, the recent emergence of UTI caused by multidrug-resistant pathogens, such as carbapenem-resistant Enterobacteriaceae (CRE), has become a great concern worldwide. CRE are mainly responsible for nosocomial infections and community-onset CRE infections in healthy individuals are rare. OBJECTIVES In this study, we report a series of infants without substantial genitourinary abnormalities that were admitted with community-onset urinary tract infections (UTIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) and we discuss their aetiology. METHODS We retrospectively reviewed the medical records of nine infants who presented from community to the paediatric ward with CRKP urinary tract infections, as well as all affected neonates of a concomitant CRKP outbreak that occurred in the neonatal intensive care unit (NICU) in a tertiary hospital (period from April 2009 to July 2012). We further retrieved all culture-proven CRKP infections of any site from 2007 to 2015 in our paediatric department. RESULTS Over a 33-month period, nine infants, all males, aged 0.9-19.3 (median 4.0) months, were admitted to the Department of Paediatrics with UTI caused by CRKP. Three of them were diagnosed with urinary tract abnormalities but only one had vesicoureteral reflux (VUR), which was a UTI-associated one. History revealed that they had all been hospitalised in the same NICU during a concurrent long-lasting CRKP outbreak for a median of 17 (2-275) days and thereafter presented with CRKP UTI 15 to 207 (median 41) days after NICU discharge. The antibiotic susceptibility and phenotypic characteristics were identical among all isolates in NICU and the paediatric ward. The summary Figure shows a timeline of NICU hospitalisation indicative of its duration and subsequent CRKP UTI of study participants is presented. CONCLUSIONS These cases illustrate that UTI caused by multidrug-resistant pathogens does not necessarily imply an underlying urinary track anomaly. Hospital acquisition of CRKP may well provoke community-onset multidrug-resistant UTI in infants months later, and this highlights the value of detailed history in patients with unusual pathogens. Cautious use of broad-spectrum antibiotics in NICUs and infection control measures would minimise the spread of multidrug-resistant pathogens in infants in the community.
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Patwardhan V, Kumar D, Goel V, Singh S. Changing prevalence and antibiotic drug resistance pattern of pathogens seen in community-acquired pediatric urinary tract infections at a tertiary care hospital of North India. J Lab Physicians 2017; 9:264-268. [PMID: 28966488 PMCID: PMC5607755 DOI: 10.4103/jlp.jlp_149_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIMS AND OBJECTIVES The aim and objective of this study was to assess the temporal changes in the microbiological profiles and antimicrobial resistance patterns of uropathogens in pediatric community-acquired UTI. MATERIALS AND METHODS This is a retrospective analysis of data collected over a Scattered period of 5 years. The baseline data collected were from January to December 2009, and the second period considered for comparison was from January to December 2014. Urine specimens from children (<17 years) suspected of UTI were cultured by a semi-quantitative method on cysteine lactose electrolyte-deficient medium. Antibiotic sensitivity was put up by Kirby-Bauer disc diffusion method as per the Clinical and Laboratory Standard Institute guidelines. RESULTS In the year 2009, 340 of 2104 (16.15%) urine specimens yielded significant colony count, whereas in 2014, it was 407 of 2212 (18.39%) (P = 0.051). Escherichia coli was the predominant pathogen and was significantly more prevalent in girls than in boys (P < 0.0001) during both periods. There was a significant overall increase in resistance to ampicillin (from 40.29% to 58.72%), amoxyclav (from 26.17% to 40.54%), nitrofurantoin (from 28.82% to 39.06%), and norfloxacin (from 30% to 41.42%). However, the maximum increase in the resistance was noted for co-trimoxazole from 35.58% in 2009 to 63.39% in 2014 (P = 0.0000058). The prevalence of extended-spectrum beta-lactamases (ESBLs) has also significantly increased from 21.7% to 33.16% (P = 0.0045). CONCLUSION Although E. coli remains the prime pathogen in pediatric UTI, the prevalence of resistance has dramatically increased over the 5-year study period. Our study highlights the emergence of community-acquired ESBL-producing uropathogens in children proclaiming treatment challenges.
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Affiliation(s)
- Vrushali Patwardhan
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dinesh Kumar
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Varun Goel
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sarman Singh
- Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
- Address for correspondence: Dr. Sarman Singh, Division of Clinical Microbiology and Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
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Tsai WL, Hung CH, Chen HA, Wang JL, Huang IF, Chiou YH, Chen YS, Lee SSJ, Hung WY, Cheng MF. Extended-spectrum β-lactamase-producing Escherichia coli bacteremia: Comparison of pediatric and adult populations. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:723-731. [PMID: 28927684 DOI: 10.1016/j.jmii.2017.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/05/2017] [Accepted: 08/17/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is increasing worldwide. This study investigated the clinical features and bacteriology of pediatric patients with ESBL-producing E. coli bacteremia and compared their characteristics with those of adult patients. METHODS Clinical and laboratory data from all of the 41 patients aged ≤18 years diagnosed with E. coli bacteremia were collected over 5 years. Patients aged >18 years diagnosed with E. coli bacteremia, matched 1:1 for calendar time, were enrolled as the adult group. All E. coli isolates were tested for their blaCTX-M group and sequence type 131 (ST131). A novel seven-single nucleotide polymorphism-based clonotyping test was applied to detect the septatypes of each isolate. RESULTS In the adult group, patients with ESBL-producing E. coli bacteremia had more previous hospitalizations and antimicrobial agent use than did those with non-ESBL-producing E. coli bacteremia, but these differences were not found in pediatric group. In the pediatric group, the proportion of isolates producing CTX-M group 9 was higher than that in the adult group (85.7% vs. 42.9%; p < 0.05). Among both groups, there were more E. coli ST131 in ESBL isolates in than there were non-ESBL isolates. The distribution of septatypes was more homogenous in ESBL-producing E. coli among the pediatric patients than among the adult patients. CONCLUSION ST131 was the major clone causing E. coli bacteremia in both pediatric and adult populations. The pediatric population demonstrated a higher number of isolates producing CTX-M group 9 with more homogenous septatypes compared with the adult population.
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Affiliation(s)
- Wan-Lin Tsai
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chih-Hsin Hung
- Department of Chemical Engineering, Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan, ROC
| | - Hui-An Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - I-Fei Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Fooyin University, Kaohsiung, Taiwan, ROC
| | - Yao-Shen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Susan Shin-Jung Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wan-Yu Hung
- Department of Chemical Engineering, Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan, ROC
| | - Ming-Fang Cheng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Fooyin University, Kaohsiung, Taiwan, ROC.
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Kim YH, Yang EM, Kim CJ. Urinary tract infection caused by community-acquired extended-spectrum β-lactamase-producing bacteria in infants. J Pediatr (Rio J) 2017; 93:260-266. [PMID: 27842212 DOI: 10.1016/j.jped.2016.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Urinary tract infection (UTI) caused by resistant strains of bacteria is increasingly prevalent in children. The aim of this study was to investigate the clinical characteristics and risk factors for UTI caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing bacteria in infants. METHODS This was a retrospective study performed over 5 years in a single Korean center. Hospitalized infants with febrile UTI were enrolled and divided into two groups (CA-ESBL vs. CA non-ESBL UTI). The yearly prevalence was calculated. Baseline characteristics and clinical course such as fever duration, laboratory and radiological findings were compared between the two groups. Risk factors associated with the CA-ESBL UTI were investigated. RESULTS Among the enrolled infants (n=185), 31 (17%) had CA-ESBL UTI. The yearly prevalence of ESBL of CA-ESBL UTI increased during the study (0% in 2010, 22.2% in 2015). Infants with CA-ESBL UTI had a longer duration of fever after initiating antibiotics (2.0±1.1 vs. 1.5±0.6 days, p=0.020). Cortical defects on renal scan and early treatment failure were more frequent in CA-ESBL (64.5 vs. 42.2%, p=0.023; 22.6 vs. 4.5%, p=0.001). A logistic regression analysis revealed that urinary tract abnormalities and previous UTI were independent risk factors for CA-EBSL UTI (odds ratio, 2.7; p=0.025; 10.3; p=0.022). CONCLUSION The incidence of UTI caused by ESBL-producing bacteria has increased in Korean infants. Recognition of the clinical course and risk factors for ESLB-producing UTI may help to determine appropriate guidelines for its management.
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Affiliation(s)
- Yun Hee Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Mi Yang
- Chonnam National University Hospital, Gwangju, Republic of Korea.
| | - Chan Jong Kim
- Chonnam National University Hospital, Gwangju, Republic of Korea; Chonnam National University Medical School, Gwangju, Republic of Korea
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Kim YH, Yang EM, Kim CJ. Urinary tract infection caused by community‐acquired extended‐spectrum β‐lactamase‐producing bacteria in infants. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Uzodi AS, Lohse CM, Banerjee R. Risk Factors For and Outcomes of Multidrug-Resistant Escherichia coli Infections in Children. Infect Dis Ther 2017; 6:245-257. [PMID: 28374267 PMCID: PMC5446365 DOI: 10.1007/s40121-017-0152-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 01/09/2023] Open
Abstract
Introduction The recent increase in multidrug-resistant (MDR) Escherichia coli infections is not well described in children. We determined the risk factors and outcomes of extraintestinal E. coli infections in children in our region. Methods We conducted a retrospective cohort study of children ≤18 years in Olmsted County, MN, USA, between January 1, 2012 and December 31, 2012. MDR isolates were defined as resistant to ≥3 antibiotic classes. Results A total of 368 children each contributed 1 isolate. Isolates were predominantly community-associated (82%) and from urine (90%), and outpatients (86%); 46 (13%) isolates were MDR. In multivariable analysis, genitourinary (GU) tract anomaly (OR 2.42, 95% CI 1.03–5.68), invasive devices (OR 3.48, 95% CI 1.37–8.83) and antibiotic use at presentation (OR 2.62, 95% CI 1.06–6.47) were associated with MDR E. coli. Children with MDR infections were more likely to have a complex infection (35% vs. 17%, P = 0.026), less likely to receive effective empiric antibiotics (47% vs. 74%, P < 0.001), had longer time to receipt of effective antibiotics (median 19.2 vs. 0.6 h, P < 0.001), and longer hospitalization (median 10 vs. 4 days, P = 0.029) than children with non-MDR infections. Conclusion Pediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.
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Affiliation(s)
- Adaora S Uzodi
- Pediatric Infectious Diseases Section, Our Lady of the Lake Children's Hospital, Baton Rouge, LA, USA.
| | - Christine M Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Ritu Banerjee
- Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Vanderbilt University, Nashville, TN, USA
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Uyar Aksu N, Ekinci Z, Dündar D, Baydemir C. Childhood urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and empiric therapy. Pediatr Int 2017; 59:176-180. [PMID: 27501161 DOI: 10.1111/ped.13112] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 07/08/2016] [Accepted: 07/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study investigated risk factors of childhood urinary tract infection (UTI) associated with extended-spectrum β-lactamase (ESBL)-producing bacteria (ESBL-positive UTI) and evaluated antimicrobial resistance as well as empiric treatment of childhood UTI. METHODS The records of children with positive urine culture between 1 January 2008 and 31 December 2012 were evaluated. Patients with positive urine culture for ESBL-producing bacteria were defined as the ESBL-positive group, whereas patients of the same gender and similar age with positive urine culture for non-ESBL-producing bacteria were defined as the ESBL-negative group. Each ESBL-positive patient was matched with two ESBL-negative patients. RESULTS The ESBL-positive and negative groups consisted of 154 and 308 patients, respectively. Potential risk factors for ESBL-positive UTI were identified as presence of underlying disease, clean intermittent catheterization (CIC), hospitalization, use of any antibiotic and history of infection in the last 3 months (P < 0.05). On logistic regression analysis, CIC, hospitalization and history of infection in the last 3 months were identified as independent risk factors. In the present study, 324 of 462 patients had empiric therapy. Empiric therapy was inappropriate in 90.3% of the ESBL-positive group and in 4.5% of the ESBL-negative group. Resistance to nitrofurantoin was similar between groups (5.1% vs 1.2%, P = 0.072); resistance to amikacin was low in the ESBL-positive group (2.6%) and there was no resistance in the ESBL-negative group. CONCLUSIONS Clean intermittent catheterization, hospitalization and history of infection in the last 3 months should be considered as risk factors for ESBL-positive UTI. The combination of ampicillin plus amikacin should be taken into consideration for empiric therapy in patients with acute pyelonephritis who have the risk factors for ESBL-positive UTI. Nitrofurantoin seems to be a logical choice for the empiric therapy of cystitis.
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Affiliation(s)
- Nihal Uyar Aksu
- Department of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Zelal Ekinci
- Department of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.,Division of Pediatric Nephrology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Devrim Dündar
- Department of Clinical Microbiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Canan Baydemir
- Department of Biostatistics and Medical Informatics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Nieminen O, Korppi M, Helminen M. Healthcare costs doubled when children had urinary tract infections caused by extended-spectrum β-lactamase-producing bacteria. Acta Paediatr 2017; 106:327-333. [PMID: 27891664 DOI: 10.1111/apa.13656] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/13/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022]
Abstract
AIM The impact of the emergence of antimicrobial resistant organisms has rarely been studied in children, including the healthcare costs of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. We evaluated the effect of ESBL on UTI healthcare costs and risk factors for paediatric UTIs. METHODS This retrospective case-control study covered 2005-2014 and focused on children below 16 years of age treated in a University hospital: 22 children with UTIs caused by ESBL-producing bacteria and 56 ESBL-negative UTI controls. RESULTS The median healthcare costs were 3929 Euros for the 22 ESBL patients and 1705 Euros for the 56 controls (p = 0.015). The mean and standard deviation length of hospital stay was 7.4 (5.9) days for the ESBL group and 3.6 (2.3) days for the controls (p = 0.007), and the figures for antibiotic treatment were 12.3 (5.5) days versus 5.8 (3.0) days (p < 0.001), respectively. The odd ratios for ESBL were underlying disease (6.63, p = 0.013), previous hospitalisation (6.07, p = 0.009) and antibiotic prophylaxis (5.20, p = 0.035). CONCLUSION Healthcare costs more than doubled when children had ESBL-related UTIs, mainly due to their increased length of stay. Effective oral antibiotics are urgently needed to treat paediatric infections caused by ESBL-producing bacteria.
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Affiliation(s)
- Oona Nieminen
- Tampere Center for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland
| | - Matti Korppi
- Tampere Center for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland
| | - Merja Helminen
- Tampere Center for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland
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Flammang A, Morello R, Vergnaud M, Brouard J, Eckart P. [Profile of bacterial resistance in pediatric urinary tract infections in 2014]. Arch Pediatr 2017; 24:215-224. [PMID: 28131557 DOI: 10.1016/j.arcped.2016.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 11/03/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Abstract
In pediatric units, bacteria-producing extended-spectrum-betalactamase (ESBL) have an increasing prevalence among bacteria causing febrile urinary tract infections (UTIs). The purpose of this study was to evaluate the epidemiology of bacteria resistance patterns observed in UTIs, in order to assess the current antibiotic treatment protocols. This study is based upon a single-center retrospective chart review of the cytobacteriological urine cultures performed in UTIs between 1 January and 31 December 2014, in the medical pediatric unit of the Caen University Hospital. Out of the total of 219 cases of UTI, 26.9% were recurrences of UTI, 18.3% were infections in infants less than 3 months old, 21% of the patients suffered from underlying uropathy, and 16.4% of the patients had recently been exposed to antibiotics. In 80.3% of the cases, Escherichia coli was found, while Enterococcus faecalis was found in 5.6%. The antibiograms proved that 33.5% of the bacteria were sensitive. Half of E. coli were resistant to ampicillin, 4.9% to cefixime, 4.9% to ceftriaxone, 1.1% to gentamicin, and 27.8% to trimethoprim-sulfamethoxazole. Nine E. coli and one Enterobacter cloacae produced ESBL, accounting for 4.6% of the UTIs. We did not find any bacteria-producing high-level cephalosporinase. Cefixime resistance was statistically linked to ongoing antibiotic treatment (OR=5.98; 95% CI [1.44; 24.91], P=0.014) and underlying uropathy (OR=6.24; 95% CI [1.47; 26.42], P=0.013). Ceftriaxone resistance was statistically related to ongoing antibiotic treatment (OR=6.93; 95% CI [1.45; 33.13], P=0.015). These results argue in favor of maintaining intravenous ceftriaxone for probabilistic ambulatory treatment. However, in case of hospitalization, cefotaxime can replace ceftriaxone, due to its lower ecological impact. Moreover, it is necessary to continue monitoring bacterial resistance and regularly review our treatment protocols.
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Affiliation(s)
- A Flammang
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France.
| | - R Morello
- Département de biostatistiques et de recherche clinique, CHU de Caen, avenue Georges-Clémenceau, 14033 Caen, France
| | - M Vergnaud
- Laboratoire de microbiologie, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - J Brouard
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
| | - P Eckart
- Service de pédiatrie médicale, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen, France
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Jacmel L, Timsit S, Ferroni A, Auregan C, Angoulvant F, Chéron G. Extended-spectrum β-lactamase-producing bacteria caused less than 5% of urinary tract infections in a paediatric emergency centre. Acta Paediatr 2017; 106:142-147. [PMID: 27542840 DOI: 10.1111/apa.13546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/10/2016] [Accepted: 08/15/2016] [Indexed: 01/23/2023]
Abstract
AIM The last decade has seen a significant increase in extended-spectrum β-lactamase (ESBL) secreting organisms responsible for paediatric urinary tract infections (UTIs), particularly in community-acquired infections. These expose patients to the risks of antibiotic treatment failure and renal scarring. This prospective study examined the prevalence and risk factors of febrile ESBL UTIs and their treatment in the paediatric emergency department of a university hospital. METHODS In this prospective observational study, all children from 0 to 16 years of age with febrile UTIs were included from May 2012 to April 2013. Cases with and without ESBL involvement were compared. RESULTS Of the 474 diagnosed febrile UTIs, 22 (4.6%) with a 95% confidence interval (95% CI) of 2.9-6.9 were due to an ESBL-producing organism. Escherichia coli was found in 85% of cases. Significant odds ratios (OR) for ESBL urinary tract infections were prior hospitalisation (OR 4.1, 95% CI 1.6-10.8), urinary tract abnormalities (OR 3.9, 95% CI 1.5-10.2) and previous antibiotic treatment (OR 3.1, 95% CI 1.2-8.8). All ESBL urinary tract infections had positive outcomes. CONCLUSION The prevalence of febrile ESBL urinary tract infections was less than 5% in a paediatric emergency department. This low rate was not high enough to justify changing our guidelines.
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Affiliation(s)
- Lisa Jacmel
- Paediatric Emergency Department; APHP; Necker-Enfants Malades Hospital; Paris Descartes University; Paris France
| | - Sandra Timsit
- Paediatric Emergency Department; APHP; Necker-Enfants Malades Hospital; Paris Descartes University; Paris France
| | - Agnès Ferroni
- Department of Microbiology; APHP; Necker-Enfants Malades Hospital; Paris Descartes University; Paris France
| | - Clémentine Auregan
- Paediatric Emergency Department; APHP; Necker-Enfants Malades Hospital; Paris Descartes University; Paris France
| | - François Angoulvant
- Paediatric Emergency Department; APHP; Necker-Enfants Malades Hospital; Paris Descartes University; Paris France
| | - Gérard Chéron
- Paediatric Emergency Department; APHP; Necker-Enfants Malades Hospital; Paris Descartes University; Paris France
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Cheng MF, Chen WL, Huang IF, Chen JR, Chiou YH, Chen YS, Lee SSJ, Hung WY, Hung CH, Wang JL. Urinary tract infection in infants caused by extended-spectrum beta-lactamase-producing Escherichia coli: comparison between urban and rural hospitals. Pediatr Nephrol 2016; 31:1305-12. [PMID: 26975387 DOI: 10.1007/s00467-016-3338-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an emerging problem. Compared with urban infants, rural infants may encounter different distributions of community-acquired resistant strains and various barriers to efficient management. METHODS A retrospective survey and comparison was conducted for infants with UTI caused by ESBL-producing E. coli admitted to an urban hospital (n = 111) and a rural hospital (n = 48) in southern Taiwan from 2009 to 2012. RESULTS Compared with 2009 and 2010, the total number of cases at both hospitals significantly increased in 2011 and 2012 (p < 0.001). Compared with the rural patients, the urban patients were significantly younger, and they had fewer days of fever before and after admission, fewer presentations of poor activity and poor appetite, and a lower serum creatinine level. Most of the patients had no prior history of illness, and we could not identify any significant different risk factors for acquiring ESBL-producing E. coli, such as past antimicrobial use, hospitalization, UTI, and underlying renal diseases, between the urban and rural populations. CONCLUSIONS The increase in community-acquired UTI in infants caused by ESBL-producing E. coli was similar between the urban and rural populations. Our preliminary data suggest that the rural-urban disparities were probably related to easy access to health care by the urban population. ESBL complicates disease management, and the increase in the prevalence of ESBL producers is a major health concern and requires further healthy carrier and environmental surveillance.
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Affiliation(s)
- Ming-Fang Cheng
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Fooyin University, Kaohsiung, Taiwan
| | - Wan-Ling Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pediatrics, Pingtung Branch of Veterans General Hospital-Kaohsiung, Pingtung, Taiwan
| | - I-Fei Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jung-Ren Chen
- Department of Biological Science and Technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Fooyin University, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wan-Yu Hung
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, No. 1, Sec. 1, Syuecheng Rd., Dashu District, Kaohsiung City, 84001, Taiwan (R.O.C)
| | - Chih-Hsin Hung
- Department of Chemical Engineering and Institute of Biotechnology and Chemical Engineering, I-Shou University, No. 1, Sec. 1, Syuecheng Rd., Dashu District, Kaohsiung City, 84001, Taiwan (R.O.C).
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, No.1, University Road, Tainan City, 701, Taiwan (R.O.C).
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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; 58:467-71. [PMID: 26513232 DOI: 10.1111/ped.12842] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/31/2015] [Accepted: 10/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are one of the most common bacterial infections in children and a major cause of hospitalization. In this study we investigated the clinical characteristics, causative uropathogens; their antibiotic susceptibility and resistance patterns, treatment modalities and efficacy in children hospitalized for UTI in a tertiary care setting. METHODS Patients hospitalized for an upper UTI between March 2009 and July 2014 were enrolled. The urine culture-antibiogram results and accompanying urinary tract abnormalities were recorded retrospectively. RESULTS A total of 142 patients (104 girls, 73.2%; 38 boys, 26.8%) were enrolled. Mean patient age was 32.6 ± 4.1 months. History of recurrent UTI was present in 45.8% (n = 65), with prior hospitalization in 12.0% (n = 17). Frequency of vesicoureteral reflux was 18.3% (n = 26). Gram-negative enteric microorganisms yielded growth in all culture-positive UTI and the most common microorganism was Escherichia coli (n = 114, 80.3%). Extended spectrum beta-lactamase-producing (ESBL (+)) bacterial strains were detected in 49.3% (n = 70), with third-generation cephalosporin resistance in all and increased duration of hospitalization. CONCLUSIONS The prevalence of UTI with ESBL (+) bacterial strains with multi-drug resistance is increasing in the hospitalized pediatric population, therefore rational use of antibiotics is essential.
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Affiliation(s)
- Mesut Koçak
- Department of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Asli Çelebi Tayfur
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Aysun Çaltik
- Department of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Adem Yasin Köksoy
- Department of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Zeynep Çizmeci
- Department of Microbiology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Sacit Günbey
- Department of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
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Segal Z, Cohen MJ, Engelhard D, Tenenbaum A, Simckes AM, Benenson S, Stepensky P, Averbuch D. Infants under two months of age with urinary tract infections are showing increasing resistance to empirical and oral antibiotics. Acta Paediatr 2016; 105:e156-60. [PMID: 26709717 DOI: 10.1111/apa.13322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/14/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
AIM Data on antimicrobial resistance in uropathogens in infants up to the age of three months are limited. This study characterised resistance patterns in Gram-negative uropathogens in infants up to the age of two months. METHODS Previously healthy young infants with urinary tract infections (UTIs) were studied retrospectively. Antimicrobial susceptibility was evaluated. Multidrug resistance (MDR) was defined as resistance to at least three antibiotic classes. Clinical, laboratory and outcome data were compared between infants with UTIs caused by bacteria sensitive and resistant to empirical and to oral therapy. RESULTS We evaluated 306 UTI episodes with 314 pathogens. The following resistance rates were observed: ampicillin 73.7%, cefazoline 22.1%, ampicillin/clavulanate 21.8%, cefuroxime 7.8%, gentamicin 7%; MDR 11.8%; resistant to empirical treatment 7.3% and resistant to available oral antibiotics 8.6%. Our study showed that pathogens resistant to empirical and oral therapy were more frequently isolated in non-Jewish (Arab) infants and in those of ≥30 days of age. Resistance to empirical treatment and oral antibiotics also resulted in longer mean hospital stays. CONCLUSION Resistance to antibiotics challenges empirical therapy and compromises oral treatment options in young infants with UTIs. Antimicrobial resistance patterns should be monitored in infants to determine appropriate empirical antibiotic therapy protocols.
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Affiliation(s)
- Zvi Segal
- Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Matan J. Cohen
- Clinical Microbiology and Infectious Diseases Department; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- Department of Medicine Shaare Zedek Medical Center; Faculty of Medicine; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Dan Engelhard
- Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- Pediatric Infectious Diseases Unit; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Ariel Tenenbaum
- Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Ari M. Simckes
- Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- Pediatric Nephrology; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Shmuel Benenson
- Clinical Microbiology and Infectious Diseases Department; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Polina Stepensky
- Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem Israel
| | - Diana Averbuch
- Pediatric Division; Hadassah-Hebrew University Medical Center; Jerusalem Israel
- Pediatric Infectious Diseases Unit; Hadassah-Hebrew University Medical Center; Jerusalem Israel
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