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Zaitoon H, Garkaby J, Nassrallah B, Sharkansky L, Shnaider M, Chistyakov I, Genizi J, Nathan K. Insights into Hospitalized Children with Urinary Tract Infections: Epidemiology and Antimicrobial Resistance Patterns in Israel-A Single Center Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1142. [PMID: 39334674 PMCID: PMC11431202 DOI: 10.3390/children11091142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Revised: 09/19/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024]
Abstract
Background: The escalating resistance of uropathogens in pediatric febrile urinary tract infection (F-UTI) is a global concern. This study examined changing trends in F-UTI epidemiology and resistance patterns among Israeli pediatric inpatients over a decade. Methods: Demographic, clinical, and laboratory data for children between 3 months and 18 years old with febrile UTI from 2010 to 2021 were retrieved from electronic medical records. Results: A total of 761 cases of F-UTI were identified (702 females, mean age 43 months). Escherichia coli was the most common pathogen (85.9%), followed by Pseudomonas aeruginosa (3.5%) and Klebsiella pneumoniae (3.4%). Compared with the non-complicated UTI group, the complicated UTI group had significantly higher rates of Pseudomonas aeruginosa (5.3% vs. 1.0%, p = 0.002) and Klebsiella pneumoniae (4.6% vs. 1.6%, p = 0.03). Antibiotic resistance analysis revealed significant differences between the groups: resistance to cephalexin was higher in the complicated UTI group (19.3%) compared with the non-complicated UTI group (13.4%, p = 0.03). Notably, relatively low resistance rates were observed for ceftriaxone (4.4%) and gentamicin (6.0%). Over time, a significant decreasing trend in resistance to ampicillin was observed (slope = -0.0193, p = 0.011). No significant trends were found for trimethoprim-sulfamethoxazole, cephalexin, amoxicillin-clavulanic acid, ceftriaxone, and cefuroxime. Conclusions: Significant differences in pathogen distribution and resistance patterns between complicated UTI and non-complicated UTI groups highlight the need for continuous resistance monitoring and adherence to local guidelines. For the treatment of severe community F-UTI, ceftriaxone could be a reasonable option for first-onset F-UTI. Further studies are needed to implement antibiotic stewardship and optimize usage.
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Affiliation(s)
- Hussein Zaitoon
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Jenny Garkaby
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
| | - Basheer Nassrallah
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
| | - Livnat Sharkansky
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
| | - Morya Shnaider
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
| | - Irina Chistyakov
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Jacob Genizi
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Keren Nathan
- Department of Pediatrics, Bnai Zion Medical Center, Haifa 3104802, Israel; (H.Z.); (J.G.); (B.N.); (L.S.); (M.S.); (I.C.); (K.N.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
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Ezeh PA, Olayinka BO, Bolaji RO, Babangida SA, Olowo-okere A. Phenotypic antibiotic susceptibility profile of clinical Enterobacteriaceae isolates from Kaduna State, northwest Nigeria. Access Microbiol 2024; 6:000747.v5. [PMID: 39045244 PMCID: PMC11261666 DOI: 10.1099/acmi.0.000747.v5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/07/2024] [Indexed: 07/25/2024] Open
Abstract
Background. The increasing resistance of clinical Enterobacteriaceae isolates to commonly prescribed antibiotics has been reported around the world. Data are generally lacking on the prevalence and antibiotic susceptibility profile of clinical Enterobacteriaceae isolates from Kaduna, northwest Nigeria. This study thus aimed to determine the diversity and antibiotic resistance profile of clinical Enterobacteriaceae isolates recovered from clinical specimens from patients admitted to two selected healthcare institutions in Kaduna. Methods. This was a prospective cross-sectional study conducted between September and December 2021. Non-duplicate clinical bacterial isolates recovered from various specimens were collected and identified using rapid biochemical identification kits. The susceptibility of identified Enterobacteriaceae to various antibiotics and phenotypic detection of carbapenemase enzymes were thereafter determined. The data were analysed and visualized using R software version 4.3.1. Results. Of the 500 bacterial isolates recovered from specimens collected for the purpose of clinical bacteriology diagnostics, 108 (21.6 %) were identified as Enterobacteriaceae, with Pantoea agglomerans (52, 48.1 %) and Klebsiella oxytoca (19, 17.6 %) being the most prevalent. The isolates exhibited high resistance to azithromycin (69 %) and ceftazidime (42 %), while exhibiting low resistance to amikacin (7 %) and imipenem (10 %). Among the carbapenem-resistant Enterobacteriaceae (CRE) isolates, a significant proportion (12/17, 70.6 %) tested positive for carbapenemase activity. Conclusion. This study reports a high prevalence of multidrug-resistant Enterobacteriaceae in Kaduna, northwest Nigeria. The emergence of pathogenic P. agglomerans and an alarmingly high prevalence of carbapenemase-producing CRE were also observed. The presence of carbapenemase producers in an area with low carbapenem usage and resistance rates raises significant concerns. Continuous surveillance and robust antibiotic stewardship policies are imperative to preserve the efficacy of carbapenems in this region.
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Affiliation(s)
| | | | | | | | - Ahmed Olowo-okere
- Department of Pharmaceutical Microbiology and Biotechnology, University of Abuja, FCT, Abuja, Nigeria
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Van K, Patel PH, Jones K, Jackson C, Faddoul N, Pulickal A. Association Between Antibiotic Duration and Recurrence of Urinary Tract Infection in the Neonatal Critical Care Unit. J Pediatr Pharmacol Ther 2024; 29:316-322. [PMID: 38863857 PMCID: PMC11163897 DOI: 10.5863/1551-6776-29.3.316] [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: 10/03/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2024]
Abstract
OBJECTIVES Urinary tract infection (UTI) is the most common bacterial infection in infants. Current practice guidelines suggest a treatment duration of 7 to 14 days. Suboptimal therapy may increase the risk for recurrent UTIs leading to renal scarring and possibly chronic kidney disease. The primary objective is to evaluate the duration of therapy for UTIs and its association with the incidence of recurrent UTIs in a neonatal intensive care unit (NICU). The secondary objectives are to identify the risk factors and the most common organisms for recurrent UTIs. METHODS Patients were identified via the diagnosis codes for UTIs and were included if admitted to the NICU and if they received antibiotics prior to hospital discharge. Patients were divided into 2 groups: antibiotic treatment for 7 days or fewer and antibiotic treatment for greater than 7 days. RESULTS Eighty-six infants were included in the study. Twenty-six patients received antibiotics for 7 days or fewer, and 60 for more than 7 days. In the study, the median birth weight was 977 g and the median gestational age was 27.6 weeks. There was no significant difference in the rate of recurrent UTIs between the 2 groups (p = 0.66). However, in the subgroup analysis, the incidence was higher for patients receiving antibiotic therapy for fewer than 7 days versus 7 days (p = 0.03). CONCLUSION There was no difference in recurrence of UTI between treatment groups (≤7 days versus >7 days), and recurrence was seen in a higher percentage of patients with a urinary tract anomaly.
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Affiliation(s)
- Kimberly Van
- Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study
| | - Priyanka H. Patel
- Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study
| | - Kristen Jones
- Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study
| | - Christopher Jackson
- Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study
| | - Najla Faddoul
- Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study
| | - Anoop Pulickal
- Department of Pharmacy (KV, PHP, KJ, CJ, NF, AP), AdventHealth for Children, Orlando, FL. NF was a pharmacy student at the University of Florida College of Pharmacy at the time of this study
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Forte J, Maurizi L, Fabiano MG, Conte AL, Conte MP, Ammendolia MG, D'Intino E, Catizone A, Gesualdi L, Rinaldi F, Carafa M, Marianecci C, Longhi C. Gentamicin loaded niosomes against intracellular uropathogenic Escherichia coli strains. Sci Rep 2024; 14:10196. [PMID: 38702355 PMCID: PMC11068731 DOI: 10.1038/s41598-024-59144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/08/2024] [Indexed: 05/06/2024] Open
Abstract
Urinary tract infections (UTIs) are the most common bacterial infections and uropathogenic Escherichia coli (UPEC) is the main etiological agent of UTIs. UPEC can persist in bladder cells protected by immunological defenses and antibiotics and intracellular behavior leads to difficulty in eradicating the infection. The aim of this paper is to design, prepare and characterize surfactant-based nanocarriers (niosomes) able to entrap antimicrobial drug and potentially to delivery and release antibiotics into UPEC-infected cells. In order to validate the proposed drug delivery system, gentamicin, was chosen as "active model drug" due to its poor cellular penetration. The niosomes physical-chemical characterization was performed combining different techniques: Dynamic Light Scattering Fluorescence Spectroscopy, Transmission Electron Microscopy. Empty and loaded niosomes were characterized in terms of size, ζ-potential, bilayer features and stability. Moreover, Gentamicin entrapped amount was evaluated, and the release study was also carried out. In addition, the effect of empty and loaded niosomes was studied on the invasion ability of UPEC strains in T24 bladder cell monolayers by Gentamicin Protection Assay and Confocal Microscopy. The observed decrease in UPEC invasion rate leads us to hypothesize a release of antibiotic from niosomes inside the cells. The optimization of the proposed drug delivery system could represent a promising strategy to significatively enhance the internalization of antimicrobial drugs.
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Affiliation(s)
- Jacopo Forte
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Linda Maurizi
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Maria Gioia Fabiano
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Antonietta Lucia Conte
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Maria Pia Conte
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Maria Grazia Ammendolia
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
| | - Eleonora D'Intino
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Angela Catizone
- Dipartimento Scienze Anatomiche, Istologiche, Medico Legali e Dell'Apparato Locomotore, Sapienza Università di Roma, Via Scarpa, 16, 00161, Rome, Italy
| | - Luisa Gesualdi
- Dipartimento Scienze Anatomiche, Istologiche, Medico Legali e Dell'Apparato Locomotore, Sapienza Università di Roma, Via Scarpa, 16, 00161, Rome, Italy
| | - Federica Rinaldi
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy.
| | - Maria Carafa
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Carlotta Marianecci
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Catia Longhi
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Piazzale Aldo Moro, 5, 00185, Rome, Italy
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Predavec N, Perčinić A, Herljević Z, Rezo Vranješ V, Pavlović M, Šalek Z, Kuliš T, Bilić E, Mareković I. Bacteriuria in Paediatric Oncology Patients: Clinical Features, Distribution and Antimicrobial Susceptibility of Bacterial Pathogens at University Hospital Centre Zagreb, Croatia over a 4-Year Period. Antibiotics (Basel) 2024; 13:118. [PMID: 38391504 PMCID: PMC10886334 DOI: 10.3390/antibiotics13020118] [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: 12/29/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Bacteriuria in paediatric oncology patients have not been well studied. This retrospective study analysed clinical features, distribution and antimicrobial susceptibility of bacterial pathogens cultured from urine in paediatric oncology patients over a 4-year period (2019-2022). A total of 143 episodes of bacteriuria were documented in 74 patients. Neutropenia was present in 17.5% (25/143), symptoms in 25.9% (37/143) and urinary catheter in 7.0% (10/143) episodes. Symptomatic bacteriuria episodes were statistically significantly more frequent in patients with neutropenia (p = 0.0232). The most common bacterial pathogens were Escherichia coli (n = 49; 32.2%), Klebsiella spp. (n = 34; 22.4%), Pseudomonas aeruginosa (n = 22; 14.5%) and Enterococcus spp. (n = 21; 13.8%). Extended-spectrum β-lactamases-producing (ESBL) Enterobacterales were found in 11 episodes (11/143; 7.7%) with the highest proportion among Klebsiella pneumoniae isolates (n = 7/34; 20.6%). No carbapenem-resistant Enterobacterales, multidrug-resistant P. aeruginosa or vancomycin-resistant Enterococcus spp. were found. The most important novelties are demonstrating P. aeruginosa as one of the prominent bacteriuria pathogens in this patient population, presence of ESBL isolates and carbapenem-resistant P. aeruginosa later during hospitalization highlights the need for appropriate antimicrobial treatment. However, because of the small number of symptomatic patients, further studies are needed to clarify the importance of including urine culture in the diagnostic process in patients with febrile neutropenia.
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Affiliation(s)
- Nina Predavec
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Antonio Perčinić
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zoran Herljević
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Violeta Rezo Vranješ
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Maja Pavlović
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Zrinko Šalek
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Tomislav Kuliš
- Department of Urology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Ernest Bilić
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivana Mareković
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Montini G, Tessitore A, Console K, Ronfani L, Barbi E, Pennesi M. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics 2024; 153:e2023062598. [PMID: 38146260 DOI: 10.1542/peds.2023-062598] [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] [Accepted: 08/09/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Febrile urinary tract infection (fUTI) in well-appearing children is conventionally treated with a standard 10-day course of oral antibiotic. The objective of this study is to determine the noninferiority (5% threshold) of a 5-day amoxicillin-clavulanate course compared with a 10-day regimen to treat fUTIs. METHODS This is a multicenter, investigator-initiated, parallel-group, randomized, controlled trial. We randomly assigned children aged 3 months to 5 years with a noncomplicated fUTI to receive amoxicillin-clavulanate 50 + 7.12 mg/kg/day orally in 3 divided doses for 5 or 10 days. The primary end point was the recurrence of a urinary tract infection within 30 days after the completion of therapy. Secondary end points were the difference in prevalence of clinical recovery, adverse drug-related events, and resistance to amoxicillin-clavulanic acid and/or to other antibiotics when a recurrent infection occurred. RESULTS From May 2020 through September 2022, 175 children were assessed for eligibility and 142 underwent randomization. The recurrence rate within 30 days of the end of therapy was 2.8% (2/72) in the short group and 14.3% (10/70) in the standard group. The difference between the 2 groups was -11.51% (95% confidence interval, -20.54 to -2.47). The recurrence rate of fUTI within 30 days from the end of therapy was 1.4% (1/72) in the short group and 5.7% (4/70) in the standard group (95% confidence interval, -10.4 to 1.75). CONCLUSIONS This study demonstrates that a 5-day course is noninferior to a 10-day course of oral amoxicillin-clavulanate.
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Affiliation(s)
- Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Antimo Tessitore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Karen Console
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Department of Clinical Epidemiology, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Adeleye QA, Ndubuisi EC, Isa FA. Etiologic and Anti-microbial Susceptibility Profiles of Bacterial Urinary Tract Infection and Bacterial Enteritis among Children at a Private Multi-Specialty Healthcare Facility in Abuja, Nigeria: A 5-Year Separate and Comparative Review. Niger J Clin Pract 2024; 27:35-46. [PMID: 38317033 DOI: 10.4103/njcp.njcp_299_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/20/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Urinary tract infection (UTI) and enteritis are major causes of morbidity and mortality in children. A combined profiling of UTI and enteritis could be helpful since stool plays a major role in the etiopathogenesis of UTI. AIM This study aimed to examine and compare bacterial UTI and bacterial enteritis in respect of their etiology and anti-microbial susceptibility (AMS) in children aged 0 to 17 years at Alliance Hospital, Abuja. MATERIALS AND METHODS This is a retrospective descriptive study of urine cultures in children who were investigated for UTI and of stool cultures in those investigated for enteritis. Data of 543 urine cultures and 614 stool cultures from January 1, 2017 to May 31, 2022 were retrieved. Bacterial yields, percentage susceptibility (PS), log-normalized susceptibility value (SVn), percentage of multi-drug-resistant (MDR) pathogens, and multiple anti-microbial resistance index (MARI) were computed and compared. RESULTS The bacterial yields of urine and stool cultures were 29% and 34%, respectively. Escherichia coli was the most common bacterial cause of UTI and enteritis. Overall susceptibility was sub-optimal and similar between uropathogens and enteropathogens [PS, 64% vs. 62%; mean SVn, 5.75 vs. 5.62 (P = 0.564)]. Levofloxacin was the most effective anti-microbial agent against both uro- and entero-pathogens, while amoxicillin clavulanate and cotrimoxazole were among the least effective. The burdens of MDR uro- and entero-pathogens were 39% and 46%, and their MARIs were 0.36 and 0.38, respectively. CONCLUSIONS Like in many healthcare institutions, Escherichia coli is the most common bacterial cause of UTI and enteritis in children at our facility. Second-generation fluoroquinolones remain effective against bacterial UTI and bacterial enteritis in children. Stool AMS surveillance could potentially be a surrogate strategy for urine AMS surveillance in children. Training and re-training on anti-microbial stewardship remain crucial in Nigeria.
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Affiliation(s)
- Q A Adeleye
- Department of Paediatrics, Alliance Hospital, Abuja, Nigeria
- Faculty of Paediatrics, National Postgraduate Medical College of Nigeria, Nigeria
- Department of Maternal and Child Health, School of Public Health, James Lind Institute, Geneva, Switzerland
| | - E C Ndubuisi
- Department of Medical Laboratory Science, Alliance Hospital, Abuja, Nigeria
| | - F A Isa
- Department of Paediatrics, Alliance Hospital, Abuja, Nigeria
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Cai T, Novelli A, Tascini C, Stefani S. Rediscovering the value of fosfomycin trometamol in the era of antimicrobial resistance: A systematic review and expert opinion. Int J Antimicrob Agents 2023; 62:106983. [PMID: 37748624 DOI: 10.1016/j.ijantimicag.2023.106983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
The worldwide prevalence of uncomplicated lower urinary tract infections (uUTIs) caused by multidrug-resistant Escherichia coli is increasing. To address this emergency, international guidelines recommend reducing administration of fluoroquinolones, in the context of growing resistance and the long-lasting and potentially disabling side effects of these drugs. The favoured drug to replace fluoroquinolones is fosfomycin trometamol (FT), a well-known derivate of phosphonic acid with broad-spectrum activity against Gram-negative and Gram-positive bacteria, including multidrug-resistant (MDR) strains. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recently reduced the susceptibility breakpoint for E. coli from 32 mg/L to 8 mg/L regarding FT used for uUTIs. This might lead to increased appropriate use of oral fosfomycin target therapy against E. coli and other microorganisms, and may be associated with a high likelihood of success. For species such as Klebsiella spp, particularly MDR strains, the absence of clinical breakpoints might lead to reduced use of oral fosfomycin, particularly if minimum inhibitory concentration is not available. To address this issue, this review presents an overview of the preclinical evidence on the activity of FT, and a systematic review of the clinical activity of FT in uUTIs in women, and in the prevention of infectious complications after prostate biopsy. The findings indicate that the safety and microbiological and clinical effectiveness of a single oral dose of FT are similar to that for comparator regimens with longer treatment schedules in women with uUTI, and FT can be considered a viable alternative to fluoroquinolones for antimicrobial prophylaxis in prostate biopsy. These observations and a broad clinical experience support the empirical use of FT for treating uUTI and indicate that FT is a promising candidate to effectively counteract antibiotic-resistant uUTIs throughout Europe.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Carlo Tascini
- Department of Medicine (DAME), Infectious Diseases Clinic, University of Udine, Udine, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Wanke-Rytt M, Sobierajski T, Lachowicz D, Seliga-Gąsior D, Podsiadły E. Analysis of Etiology of Community-Acquired and Nosocomial Urinary Tract Infections and Antibiotic Resistance of Isolated Strains: Results of a 3-Year Surveillance (2020-2022) at the Pediatric Teaching Hospital in Warsaw. Microorganisms 2023; 11:1438. [PMID: 37374940 DOI: 10.3390/microorganisms11061438] [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: 03/09/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Urinary tract infections (UTIs) remain the most common infections diagnosed in outpatients and hospitalized patients. This study was designed to determine the patterns of antibiotic resistance and the prevalence of uropathogens causing UTIs in pediatric patients hospitalized between 1 January 2020 and 31 December 2022 at Teaching Hospital in Warsaw. The most frequent species isolated from urine samples were E. coli (64.5%), Klebsiella spp. (11.6%), and Enterococcus spp. (6.1%). UTIs caused by Enterobacter spp., Enterococcus spp., and Klebsiella spp. were significantly more common in children younger than three months of age than in children older than three months (p < 0.001). Trimethoprim and trimethoprim-sulfamethoxazole were the least active compounds against Enterobacterales with the resistance of E. coli, Klebsiella spp., P. mirabilis, and Enterobacter spp. in the range of 26.7/25.2%, 48.4/40.4%, 51.1/40.4%, and 15.8/13.2% respectively. Ampicillin was also found to have resistance rates for E. coli of 54.9% and P. mirabilis of 44.7%. Cefalexin and cefuroxime were highly active towards Enterobacterales except for Klebsiella spp., in which the resistance level reached 40%. Regarding third- and fourth- generation cephalosporins, resistance in E. coli and P. mirabilis was observed in approximately 2-10% of the isolates, but in Klebsiella spp. and Enterobacter spp. ranged over 30%. The resistance of Enterobacterales to carbapenems, nitrofurantoin, and fosfomycin was below 1%. The quinolones resistance was very high for Klebsiella spp. (31.1%) and P. mirabilis (29.8%) and three times lower for E. coli (11.9%), P. aeruginosa (9.3%), Enterobacter spp. (2.6%), and E. faecalis (4.6%). Resistance to multiple antibiotic classes was identified in 396 Enterobacterales strains, 394 of which were multi-drug resistant (MDR) and 2 were extensive drug-resistant (XDR). In the case of E. coli, 30% of isolates were MDR, with the proportion of strains having this exact resistance pattern similar in all of the analyzed years; no E. coli XDR strains were isolated. The number of Klebsiella spp. MDR strains was much higher in 2022 (60%) than in 2021 (47.5%). In the analyzed time, only one strain of K. pneumonia XDR, producing New Delhi metallo-β-lactamase, was isolated. Monitoring infection trends is essential to improve control and limit the rise of bacterial resistance.
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Affiliation(s)
- Monika Wanke-Rytt
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 63a Zwirki i Wigury Str., 02-091 Warsaw, Poland
| | - Tomasz Sobierajski
- The Sociomedical Research Centre, Faculty of Applied Social Sciences and Resocialization, Warsaw University, 26/28 Krakowskie Przedmiescie Str., 00-927 Warsaw, Poland
| | - Dominika Lachowicz
- Laboratory of Microbiology, University Center of Laboratory Medicine, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Dominika Seliga-Gąsior
- Laboratory of Microbiology, University Center of Laboratory Medicine, 1a Banacha Str., 02-097 Warsaw, Poland
| | - Edyta Podsiadły
- Laboratory of Microbiology, University Center of Laboratory Medicine, 1a Banacha Str., 02-097 Warsaw, Poland
- Department of Pharmaceutical Microbiology and Bioanalysis, Centre for Preclinical Research, Faculty of Pharmacy, Medical University of Warsaw, 1b Banacha Str., 02-097 Warsaw, Poland
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10
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Purcell R, Yeoh D, Bowen A, Britton PN, Carr JP, Chen M, Cheung K, Clark J, Irwin A, Lai T, Lorenzen U, Steer A, Wen S, Williams P, Yap N, Cooper C, Gwee A. A multicentre, retrospective audit of fosfomycin use for urinary tract infections in Australian children and adolescents. J Antimicrob Chemother 2023:7163425. [PMID: 37190910 DOI: 10.1093/jac/dkad131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) due to MDR organisms are increasingly common. The lack of paediatric data on efficacious antibiotics makes UTI treatment particularly challenging. Data on the efficacy of fosfomycin use for UTI in children are variable. METHODS We conducted a retrospective audit of children aged 0-18 years who were treated with fosfomycin for UTI at seven tertiary paediatric hospitals in Australia over a 7 year period, from 2014 to 2020. RESULTS Ninety-one children with a median age of 5 years (range 2 months to 18 years) received oral fosfomycin for UTI. The majority (57/91, 63%) had one or more comorbidity, with the most common being renal tract anomalies (24/91, 26%). Fifty-nine (65%) had febrile UTI, 14/91 (15%) had pyelonephritis and 1/91 (1%) was bacteraemic. A majority (80/91, 88%) of urinary cultures had an ESBL-producing Gram-negative pathogen isolated. Fosfomycin susceptibility was evident in all 80 isolates tested. For uncomplicated UTI, the most common dose in children aged <1, 1-12 and >12 years was 1, 2 and 3 g, respectively. For complicated UTI, doses of 2 and 3 g were most common. The median duration of fosfomycin administration was 5 days (range 1-82). Clinical cure was achieved in 84/90 (93%); the six with treatment failure had underlying comorbidities. Overall, 2/91 (2%) children experienced drug-related adverse effects comprising gastrointestinal symptoms in both, which resolved after treatment discontinuation. CONCLUSIONS Fosfomycin is well tolerated and associated with favourable treatment outcomes in children with UTI. Further research on the optimal dosing strategy is required.
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Affiliation(s)
- Rachael Purcell
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Health Informatics Group, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Bioinformatics Group, Centre for Health Analytics, Royal Children's Hospital, Melbourne, Australia
| | - Daniel Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Asha Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia
- Westfarmer Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network, Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
| | - Jeremy P Carr
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ming Chen
- Department of Infectious Diseases, Adelaide Women's and Children's Hospital, Adelaide, Australia
| | - Kaman Cheung
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Australia
| | - Julia Clark
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam Irwin
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tony Lai
- Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network, Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
| | - Ulrik Lorenzen
- Department of Infectious Diseases, Adelaide Women's and Children's Hospital, Adelaide, Australia
| | - Andrew Steer
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sophie Wen
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Phoebe Williams
- Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network, Sydney, Australia
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Natalie Yap
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Adelaide Women's and Children's Hospital, Adelaide, Australia
- National Centre for Antimicrobial Stewardship, Adelaide, Australia
| | - Amanda Gwee
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Infectious Diseases Group, Murdoch Children's Research Institute, Melbourne, Australia
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11
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Shinu P. Antimicrobial Resistance, Phenotypic Characteristics, and Biofilm Production in Citrobacter freundii Isolates Obtained from Urinary Tract Infections. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x221147747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To evaluate the link between phenotypic traits, antimicrobial resistance, and biofilm-producing capacity of urinary isolates of Citrobacter freundii ( C. freundii). Methods Both pan-antibiotic-susceptible and -resistant C. freundii isolates ( n = 120) obtained from laboratory-confirmed urinary tract infections were analyzed for their link between antimicrobial resistance, phenotypic characteristics, and biofilm production. Results Of the total C. freundii isolates ( n = 120), 30% (37/120) of them formed large colonies. Among the total large colonies produced ( n = 37), they were present in 21.62%, 10.81%, 13.5%, 16.2%, 21.62%, and 16.21% in the control group, CIP-group, FOS-group, COT-group, Gent-group, and ESBL groups, respectively. Compared to the pan-susceptible isolates, the occurrence of large-sized-colony-forming strains was relatively reduced in most of the drug-resistant groups. The overall distribution of mucoid colonies produced ( n = 54) includes 9.25%, 18.51%, 16.66%, 18.51%, 20.3%, and 16.66% in the control group, CIP-group, FOS-group, COT-group, Gent-group, and ESBL groups, respectively. Of the total isolates that produced biofilm ( n = 51), 11.76% of isolates showed biofilm formation in the control group. Alternatively, the rate was found to be 15.68%, 11.76%, 25.49%, 19.6%, and 15.68% in the CIP-group, FOS-group, SXT-group, Gen-group, and ESBL-groups, respectively. Conclusion This study correlates the association between phenotypic characteristics, antimicrobial resistance, and biofilm production, the three main characteristics of C. freundii.
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Affiliation(s)
- Pottathil Shinu
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
- Department of Microbiology, M.M. Institute of Medical Sciences and Research, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, India
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12
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Incidence and Causative Organisms of Bacteriuria in Children With Cancer: A 9-Year Experience in a Tertiary Pediatric Center. J Pediatr Hematol Oncol 2023; 45:21-24. [PMID: 35972935 DOI: 10.1097/mph.0000000000002524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
Although infection is common in patients with cancer, the distribution of causative agents and the proportion of resistant bacteria in patients with urinary tract infection remain unknown. The aim of this study was to describe the incidence, the causative agents, and the proportion of antimicrobial resistance in bacteria cultured from urine of hospitalized children with cancer. A single-center retrospective chart review of patients with cancer admitted between 2012 and 2020 was performed to identify patients with positive urine culture. Overall, 61 (0.9%) of 7107 patients were identified to have positive urine cultures. Among them, 25 patients (41%) had symptomatic bacteriuria. The most common pathogenic bacterium among all patients was Escherichia coli ( E. coli ) (n=15, 25%), followed by Enterococcus sp. (n=14, 23%), Klebsiella sp. (n=12, 20%), and Pseudomonas aeruginosa ( P. aeruginosa ) (n=12, 20%). Extended spectrum β-lactamases-producing E. coli and Extended spectrum β-lactamases-producing Klebsiella pneumoniae were detected in 1 patient (2%) and 4 patients (7%), respectively. No multidrug-resistant P. aeruginosa and vancomycin-resistant Enterococcus were detected. The incidence of bacteriuria was found to be low in children with cancer. The distribution of causative agents of bacteriuria in children with solid tumors and hematologic diseases may be different from that in previously healthy children.
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13
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Current and Emerging Treatment Options for Multidrug Resistant Escherichia coli Urosepsis: A Review. Antibiotics (Basel) 2022; 11:antibiotics11121821. [PMID: 36551478 PMCID: PMC9774639 DOI: 10.3390/antibiotics11121821] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Escherichia coli is a versatile commensal and pathogenic member of the human microflora. As the primary causative pathogen in urosepsis, E. coli places an immense burden on healthcare systems worldwide. To further exacerbate the issue, multi drug resistance (MDR) has spread rapidly through E. coli populations, making infections more troublesome and costlier to treat. This paper aimed to review the literature concerning the development of MDR in uropathogenic E. coli (UPEC) and explore the existing evidence of current and emerging treatment strategies. While some MDR strains maybe treated with β-lactam-β-lactamase inhibitor combinations as well as cephalosporins, cephamycin, temocillin and fosfomycin, current treatment strategies for many MDR UPEC strains are reliant on carbapenems. Carbapenem overreliance may contribute to the alarming dissemination of carbapenem-resistance amongst some UPEC communities, which has ushered in a new age of difficult to treat infections. Alternative treatment options for carbapenem resistant UPEC may include novel β-lactam-β-lactamase or carbapenemase inhibitor combinations, cefiderocol, polymyxins, tigecycline, aminoglycosides or fosfomycin. For metallo-β-lactamase producing strains (e.g., NDM, IMP-4), combinations of cefazidime-avibacam with aztreonam have been used. Additionally, the emergence of new antimicrobials brings new hope to the treatment of such infections. However, continued research is required to successfully bring these into the clinic for the treatment of MDR E. coli urosepsis.
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Brandström P, Hansson S. Urinary Tract Infection in Children. Pediatr Clin North Am 2022; 69:1099-1114. [PMID: 36880924 DOI: 10.1016/j.pcl.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptoms of urinary tract infection (UTI) in young children are nonspecific and urine sampling is challenging. A safe and rapid diagnosis of UTI can be achieved with new biomarkers and culture of clean-catch urine, reserving catheterization or suprapubic aspiration for severely ill infants. Most guidelines recommend ultrasound assessment and use of risk factors to direct further management of children at risk of kidney deterioration. The increasing knowledge of the innate immune system will add new predictors and treatment strategies to the management of UTI in children. Long-term outcome is good for the majority, but individuals with severe scarring can develop hypertension and decline in kidney function.
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Affiliation(s)
- Per Brandström
- Department of Pediatrics, Clinical Science Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg 416 85, Sweden; Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg 416 85, Sweden.
| | - Sverker Hansson
- Department of Pediatrics, Clinical Science Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg 416 85, Sweden; Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg 416 85, Sweden
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15
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Hassor S, Etinger V, Villacis DS, Houssay M, Bukhari A, Gruber J, Iskowitz S, Marin BF, Chinga ML, Sedor A, Rockwell M, Berrios L, Calderon R, Laufer PM, Gupta A, Salyakina D, Clemente M. A Case-Control Study Evaluating Risk Factors and Outcomes of Hospitalized Children With ESBL-UTI. Clin Pediatr (Phila) 2022; 61:759-767. [PMID: 35883255 DOI: 10.1177/00099228221100064] [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] [Indexed: 11/16/2022]
Abstract
Urinary tract infections (UTIs) are among the most common causes of hospitalization in children, with a rising prevalence of extended-spectrum beta-lactamase-producing organisms (ESBL). The purpose of this study was to identify risk factors and treatment outcomes of children with ESBL-UTI. A retrospective case-control study of hospitalized children was performed from July 2014 till December 2017. Medical records from patients with a positive urine culture were reviewed and included in the study if they met criteria for UTI. Cases were defined as ESBL-UTI, while controls were defined as non-ESBL-UTI patients. This study confirmed that there are certain risk factors, such as previous UTI, recent antibiotic use, urinary tract abnormalities, recent hospital admission, and nonrenal comorbidities, that are associated with ESBL-UTI. Most of the patients with ESBL-UTI responded to discordant antibiotics. Other significant outcomes in patients with ESBL-UTI included a longer length of stay and longer intravenous antibiotic therapy.
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16
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Dejonckheere Y, Desmet S, Knops N. A study of the 20-year evolution of antimicrobial resistance patterns of pediatric urinary tract infections in a single center. Eur J Pediatr 2022; 181:3271-3281. [PMID: 35739294 DOI: 10.1007/s00431-022-04538-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 11/03/2022]
Abstract
Febrile urinary tract infections (UTIs) are important bacterial infections in children but increasingly difficult to treat due to antimicrobial resistance. We performed a retrospective analysis of the prevalence of uropathogens in hospitalized children with a febrile UTI between 2000 and 2019 in our university hospital to get more insight into trend and determinants of antimicrobial resistance over time. There were 1010 hospitalizations in children with a median age of 1.1 years. Thirty-six percent had an abnormal ultrasound and/or the presence of vesico-ureteral reflux, defined as CAKUT. Escherichia coli was the most prevalent pathogen (76%). However, there was an increasing prevalence towards other gram-negative organisms over time, and these pathogens were more common in children with congenital anomalies of kidney and urinary tract (CAKUT) (OR 4.26 (3.14-5.78), p < 0.001). E. coli strains demonstrated an increase in resistance against amoxicillin clavulanic acid (AMC) over time from 16% (2000-2004) to 36% (2015-2019) with an average increase of 2.0%/year; this was + 1.1%/year for third-generation cephalosporin. Multivariate analysis demonstrated that prior antibiotic use was an additional risk factor for antimicrobial resistance in E. coli. Nevertheless, increasing resistance was also observed in children without reported previous antibiotic treatment (+ 1.9%/year, p = 0.04). Conclusion: We observed a significant pattern of increasing antimicrobial resistance of E. coli within a relatively short period of time, making it increasingly difficult to treat pediatric UTIs. This pattern was also seen in children without underlying risk factors (recent antibiotic treatment or structural urological disease). This is indicative for a larger problem in the general population and an important threat to our current standard of health care. What is Known: • Escherichia coli is the most frequent pathogen in pediatric urinary tract infections. • There is an increasing antimicrobial resistance against commonly used antibiotics in urinary tract infections. What is New: • The first 20-year retrospective, longitudinal study on characteristics of the microorganisms of pediatric urinary tract infections in a single center. • A 1-2% yearly increase in antimicrobial resistance, not only in children with congenital anomalies of the kidneys or recent antibiotic treatment but also in children without risk factors.
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Affiliation(s)
| | | | - Noël Knops
- Dept of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium
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17
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Management of Pediatric Urinary Tract Infections: A Delphi Study. Antibiotics (Basel) 2022; 11:antibiotics11081122. [PMID: 36009990 PMCID: PMC9404756 DOI: 10.3390/antibiotics11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis.
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18
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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: 7] [Impact Index Per Article: 3.5] [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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19
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Sarra S, Arsene MMJ, Grigorievna VE, Victorovna PI, Vyacheslavovna YN, Nikolaïevna BM. Antibiotic resistance pattern of uropathogenic Escherichia coli isolated from children with symptomatic urinary tract infection in Moscow, Russia. INTERNATIONAL JOURNAL OF ONE HEALTH 2021. [DOI: 10.14202/ijoh.2021.212-219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Uropathogenic Escherichia coli (UPEC) is commonly involved in urinary tract infections (UTIs), which are generally treated with antibiotics. However, the emergence of multidrug-resistant (MDR) strains of UPEC has made the treatment difficult. There is thus a need to continuously assess their sensitivity to antibiotics. This study aimed to determine the antibiotic resistance patterns and MDR phenotypes of UPEC strains isolated from children diagnosed with UTIs at the Russian Children's Clinical Hospital in Moscow, Russia.
Materials and Methods: Kirby–Bauer's disc diffusion method was used to study the sensitivity to antibiotics of 106 UPEC isolates from urine specimens from children (aged from 9 months to 18 years old) diagnosed with UTIs. The results were interpreted in accordance with the Clinical and Laboratory Standards Institute guidelines and the correlations of variables with the degree to which each antibiotic inhibited the UPEC strains in terms of diameter on the disc were determined using Spearman's rank correlation test. A t-test and principal component analysis were performed to visualize the correlations of the susceptibility of UPEC to antibiotics with the age and sex of the patients. Statistical significance was set at p≤0.05.
Results: Among the 106 UPEC strains tested, none (0%) showed resistance to fosfomycin (FO), while 84 (79.2%) were resistant (R) to at least one antibiotic. The highest rates of resistance were observed to amoxicillin (69.8%), ampicillin (62.3%), cefazolin (39.6%), trimethoprim (TR) (37.7%), ceftriaxone (34.9%), and tetracycline (33.0%). Interestingly, 22 (20.8%) strains were R to imipenem. UPEC isolates from males aged 1-6 years were more R to antibiotics than those from the other groups, with the exception of TR, to which UPEC isolates from females aged 13-18 years old were less sensitive (S). The multidrug-resistance (MDR) index ranged between 0.00 and 0.75 and we found that more than a quarter of UPEC (31/106) had an MDR index ≥0.5 and only 22 (20.7%) strains were S to all antibiotics tested (MDR index=0). Finally, Spearman's rank correlation test showed that, with the exception of FO, there were correlations between the inhibition diameters of all other antibiotics.
Conclusion: FO is the only antibiotic to which all UPECs were S and may be suggested as the first line of treatment for UPEC. Further research is needed to continue monitoring antibiotic resistance and to investigate the genetic features associated with such resistance observed in this study.
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Affiliation(s)
- Souadkia Sarra
- Department of Microbiology and Virology, Institute of Medicine, RUDN University, Moscow, Russia
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20
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Mitra SD, Irshad P, Anusree M, Rekha I, Shailaja S, Suresh J, Aishwarya G, Shrestha S, Shome BR. Whole genome global insight of antibiotic resistance gene repertoire and virulome of high - risk multidrug-resistant Uropathogenic Escherichiacoli. Microb Pathog 2021; 161:105256. [PMID: 34695556 DOI: 10.1016/j.micpath.2021.105256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/06/2021] [Accepted: 10/14/2021] [Indexed: 12/17/2022]
Abstract
Elucidation of genetic determinants via whole genome sequence (WGS) analyses can help understand the high risk multidrug-resistant (MDR) Uropathogenic Escherichia coli (UPEC) associated with urinary tract infections (UTI) and its evasion strategies from treatment. We investigated the WGS of 30 UPEC strains from UTI samples across the world (2016-2019) and found 25 UPEC strains carrying 2-23 antibiotic resistance genes (ARGs) scattered across 1-3 plasmids per strain. Different ARGs (blaTEM, blaCTXM, blaNDM, blaOXA, blaCMY) encoding extended-spectrum beta-lactamases (TEM, CTXM, CMY) and carbapenemases (NDM, OXA) were found in 24/30, ARGs encoding aminoglycoside modifying enzymes (AAC, APH, AAD) variants in 23/30, trimethoprim ARGs (dfrA17, dfrA12, dfrA5, dfrB4 variants) encoding dihydrofolate reductase in 19/30 and sulfonamide ARGs (sul1, sul2, sul3) encoding dihydropteroate synthase and macrolide ARGs (mph1) encoding macrolide 2' phosphotransferase in 15/30 UPEC strains. Collectively the ARGs were distributed in different combinations in 40 plasmids across UPEC strains with 20 plasmids displaying co-occurrence of multiple ARGs conferring resistance to beta lactam, aminoglycoside, sulfonamide, trimethoprim and macrolide antibiotics. These resistance plasmids belonged to seven incompatibility groups (IncF, IncI, IncC, IncH, IncN, IncB and Col), with IncFI and IncFII being the predominant resistance plasmids. Additionally, we observed co-occurrence of specific mutation pattern in quinolone resistance determining region (QRDR) viz., DNA gyrase (gyrA: S83L, D87N), and topoisomerase IV (parC: S80I, E84V; parE: I529L) in 18/30 strains. The strains also harbored diverse virulence genes, such as fimH, gad, iss, iha, ireA, iroN, cnf1 and san. Multilocus sequence typing (MLST) reconfirmed ST131(n = 10) as the predominant global high-risk clonal strain causing UTI. In summary, our findings contribute to better understand the plasmid mediated ARGs and its encoded enzymes that may contribute in antibiotic inactivation/modification or alteration in the antibiotic target site in high risk MDR hypervirulent UPEC strains causing UTI. The study reinforces the need to characterize and design appropriate inhibitors to counterattack different enzymes and devise strategies to curtail resistance plasmid.
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Affiliation(s)
- Susweta Das Mitra
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India.
| | - Pir Irshad
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - M Anusree
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - Injeti Rekha
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - S Shailaja
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - Janshi Suresh
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - G Aishwarya
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - Smeeta Shrestha
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, 560078, India
| | - Bibek Ranjan Shome
- ICAR- National Institute of Veterinary Epidemiology & Disease Informatics, Bangalore, India
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21
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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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22
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Purcell R, Wang N, Gwee A. Can fosfomycin be used for the treatment of Gram-negative urinary tract infections in children? Arch Dis Child 2021; 106:925-928. [PMID: 33461959 DOI: 10.1136/archdischild-2020-320529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Rachael Purcell
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nelson Wang
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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23
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Extensive drug-resistance in strains of Escherichia coli and Klebsiella pneumoniae isolated from paediatric urinary tract infections. J Taibah Univ Med Sci 2021; 16:565-574. [PMID: 34408614 PMCID: PMC8348552 DOI: 10.1016/j.jtumed.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 01/29/2023] Open
Abstract
Objectives Urinary tract infections (UTIs) in children are rapidly increasing worldwide and are commonly caused by extensively drug-resistant bacteria. This study determines the prevalence of UTIs in paediatric patients and evaluates the pattern of extensively drug-resistance in Escherichia coli and Klebsiellapneumoniae strains isolated from paediatric UTI patients. Methods Uropathogenic bacterial strains were isolated from paediatric patients with UTIs admitted to the Institute of Child Health, Lahore, Pakistan. Strains of both E. coli and K. pneumoniae were identified using biochemical characterisation and subjected to antibiotic susceptibility assays for 21 common antimicrobial drugs in order to determine their extensively drug-resistant profile. Results We isolated 63 E. coli and 37 K. pneumoniae strains from 130 paediatric patients with UTIs over a period of six months. The antibiotic susceptibility assays showed that both the E. coli and K. pneumoniae strains exhibited a high degree of resistance against co-amoxiclav, cefuroxime, cefixime, cefotaxime, ceftazidime, ceftriaxone, ciprofloxacin, nalidixic acid, norfloxacin, pepedemic acid, and co-trimoxazole. However, several of the antimicrobial agents, including polymyxin B, colistin sulphate, chloramphenicol, nitrofurantoin, and fosfomycin, were found to retain their antimicrobial activities against both pathogens. The five highest antibiotic resistant strains were identified as E. coli strains ZK9, ZK40, and ZK60 and K. pneumoniae ZK32 and ZK89 using 16S rRNA gene sequencing. Conclusion Our study demonstrates that E. coli and K. pneumonia are the dominant extensively drug-resistant uropathogenic bacteria in community-acquired UTIs in our cohort. These uropathogens were found to be resistant to the majority of the routinely-used classes of β-lactams, pyridopyrimidines, quinolones, and fluoroquinolone antibiotics, and these findings may be useful for clinicians in their treatment of paediatric UTIs.
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24
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Polat M, Ozkaya-Parlakay A, Tapısız A, Kara SS, Yüksel S. Oral fosfomycin for treating lower urinary tract infections due to multidrug-resistant Escherichia coli in female adolescents. J Chemother 2021; 34:97-102. [PMID: 34286658 DOI: 10.1080/1120009x.2021.1955203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Fosfomycin trometamol (FT) has shown promising in vitro activity against multidrug-resistant (MDR) uropathogens; however, clinical data are limited in pediatric patients. We conducted a retrospective study to describe the clinical and microbiological outcomes of uncomplicated lower urinary tract infections (LUTIs) due to MDR Escherichia coli treated with oral FT in female adolescents. A total of 70 outpatients, with a median age of 13 years (range 12-16 years), were included. FT was initiated as definitive treatment of UTIs in all patients due to documented resistance against alternative oral agents. All patients received a single dose of 3 g oral FT. The post-treatment clinical and microbiological cure rates were 97% (68/70) and 94% (66/70), respectively. Only two (3%) patients reported mild, self-limited diarrhea. UTI relapse occurred in two (3%) patients. Our results suggest that oral FT might be an alternative option for outpatient treatment of uncomplicated LUTIs due to MDR E. coli in female adolescents.
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Affiliation(s)
- Meltem Polat
- Department of Pediatric Infectious Diseases, Erzurum Research and Training Hospital, Erzurum, Turkey.,Faculty of Medicine, Department of Pediatric Infectious Diseases, Pamukkale University, Denizli, Turkey
| | - Aslınur Ozkaya-Parlakay
- Department of Pediatric Infectious Diseases, Yildirim Beyazit University Ankara City Hospital, Ankara, Turkey
| | - Anıl Tapısız
- Department of Pediatric Infectious, School of Medicine, Diseases Gazi University, Ankara, Turkey
| | - Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Erzurum Research and Training Hospital, Erzurum, Turkey
| | - Selçuk Yüksel
- Faculty of Medicine, Department of Pediatric Nephrology, Pamukkale University, Denizli, Turkey
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25
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Pierantoni L, Andreozzi L, Ambretti S, Dondi A, Biagi C, Baccelli F, Lanari M. Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children's Urine Cultures in an Italian Metropolitan Area. CHILDREN-BASEL 2021; 8:children8070597. [PMID: 34356576 PMCID: PMC8303248 DOI: 10.3390/children8070597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.
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Affiliation(s)
- Luca Pierantoni
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.D.); (C.B.); (M.L.)
| | - Laura Andreozzi
- Specialty School of Paediatrics—Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy;
- Correspondence:
| | - Simone Ambretti
- Unit of Clinical Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Arianna Dondi
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.D.); (C.B.); (M.L.)
| | - Carlotta Biagi
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.D.); (C.B.); (M.L.)
| | - Francesco Baccelli
- Specialty School of Paediatrics—Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy;
| | - Marcello Lanari
- Division of Pediatric Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.P.); (A.D.); (C.B.); (M.L.)
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26
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Atay N, Uslu Gökceoğlu A. Evaluation of urinalysis and urine culture in children with first-time urinary tract infection. Turk J Urol 2021; 47:242-247. [PMID: 33263517 PMCID: PMC8260084 DOI: 10.5152/tud.2020.20387] [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: 08/25/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to review results of urinalysis with flow cytometry technique at the time of diagnosis of urinary tact infection (UTI), and to determine uropathogenes with their antibiotic resistance patterns in children with first-time UTI. MATERIAL AND METHODS This single-centered, retrospective, cross-sectional study was conducted from January 2015 to December 2017. The study included 361 children with a first-time UTI diagnosis. Age, gender, results of automated urinalysis, urine culture results were recorded. RESULTS Mean ages of children were 55.8±50.7 months. E. coli was the most common isolated microorganism followed by K. pneumoniae, Proteus, Enterococcus, and P. aeroginosa. Median count of pyuria was 44 leukocyte/mm3 (range:0-2954/mm3). Median count of pyuria in female and male patients were 53 and 22 leukocyte/mm3, respectively (p=0047). A total of 98 patients (27.1%) had no pyuria. Proportion of pyuria in female and male patients were 81.2% and 76%, respectively (p>0.05). Mean age of patients with and without pyuria were 59±52 months and 46±44months, respectively (p<0.05). According to uropathogen, there was pyuria at the ratio of 60% in Pseudomonas, 62.5% in Enterococcus spp, 66.7% in Proteus, 78.3% in Klebsiella, and 82.7% in E. coli. Children with UTI induced by E. coli had resistance ratios of 30.5% and 22.4% to cefixime and ceftiaxone, respectively. Children with UTI by Klebsiella spp had resistance ratios of 47.8% and 39.1% to cefixime and ceftriaxone, respectively. CONCLUSION E. coli was the most common uropathogen in children with first-time UTI. Pyuria may be lacking according to age, gender, and type of uropathogene. Pyuria level was higher in females. In addition, ceftriaxone and cefixime resistance is increasing making ampirical treatment choices limited.
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Affiliation(s)
- Nursel Atay
- Department of Pediatrics, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Arife Uslu Gökceoğlu
- Department of Pediatric Nephrology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020. Antibiotics (Basel) 2021; 10:antibiotics10040447. [PMID: 33923389 PMCID: PMC8071495 DOI: 10.3390/antibiotics10040447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January–June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0–18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40–60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-β-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.
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28
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Resistance to Antibiotics of Uropathogen Bacteria Isolated From Urine and Blood in Pediatric Cancer Patients: A Single Center, 12-year Study. Pediatr Infect Dis J 2020; 39:1106-1110. [PMID: 33021597 DOI: 10.1097/inf.0000000000002854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Resistant pathogens have become a major healthcare problem in children with cancer, causing different kinds of infections such as the bloodstream ones, most common, and most frequently described and the urinary tract ones, of which less data are available. We analyzed and compared the proportions, and the trends of resistance in pathogens isolated from blood and urines in children with cancer followed in IRCCS Istituto Giannina Gaslini, Genova, Italy, from January 2007 to December 2018. Overall, 345 strains detected in urines and 282 in bloodstream infections were analyzed. Enterobacteriales were the most frequently isolated pathogens. During the study period in urines, there was a significant increase of resistance to ceftazidime, ciprofloxacin, piperacillin/tazobactam, and trimethoprim-sulfamethoxazole, but pathogens from blood were significantly more frequently resistant to amikacin, piperacillin/tazobactam, and combination therapy piperacillin/tazobactam+amikacin, even if with a decreasing trend during the study period. These data confirm the importance of surveillance of isolated microorganism and antibiotic resistance in cancer children.
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29
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Raya GB, Dhoubhadel BG, Shrestha D, Raya S, Laghu U, Shah A, Raya BB, Kafle R, Parry CM, Ariyoshi K. Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal. Trop Med Health 2020; 48:65. [PMID: 32774128 PMCID: PMC7397599 DOI: 10.1186/s41182-020-00251-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens has complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly, may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children. Methods During the study period (April 2017–April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI. Results We processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12–53 months). Escherichia coli (n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin, nitrofurantoin, and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03). Conclusions Nitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal. MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance.
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Affiliation(s)
| | - Bhim Gopal Dhoubhadel
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan.,School of Tropical Medicine and Global Health (TMGH), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
| | | | | | | | - Ashok Shah
- Siddhi Memorial Hospital, Bhaktapur, Nepal
| | | | - Rita Kafle
- Kathmandu Medical College, Kathmandu, Nepal
| | - Christopher M Parry
- School of Tropical Medicine and Global Health (TMGH), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan.,School of Tropical Medicine and Global Health (TMGH), Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
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