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Tse Y, Pickles C, Owens S, Malina M, Peace R, Gopal M. Low yield from imaging after non -E. coli urine tract infections in children treated in primary care and emergency department. Arch Dis Child 2023; 108:474-480. [PMID: 36868793 DOI: 10.1136/archdischild-2022-324930] [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: 09/22/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Imaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non-E. coli is considered high risk in many national guidelines, but evidence is mainly drawn from small cohorts from tertiary centres. OBJECTIVE To ascertain imaging yield from infants and children <12 years diagnosed with their first confirmed UTI (pure single growth >100 000 cfu per ml) in primary care or an emergency department without admission stratified by bacteria type. DESIGN, SETTING, PATIENTS Data were collected from an administrative database of a UK citywide direct access UTI service between 2000 and 2021. Imaging policy mandated renal tract ultrasound and Technetium-99m dimercaptosuccinic acid scans in all children, plus micturating cystourethrogram in infants <12 months. RESULTS 7730 children (79% girls, 16% aged <1 year, 55% 1-4 years) underwent imaging after first UTI diagnosed by primary care (81%) or emergency department without admission (13%). E. coli UTI yielded abnormal kidney imaging in 8.9% (566/6384). Enterococcus and KPP (Klebsiella, Proteus, Pseudomonas) yielded 5.6% (42/749) and 5.0% (24/483) with relative risks 0.63 (95% CI 0.47 to 0.86) and 0.56 (0.38 to 0.83)), respectively. No difference was found when stratified by age banding or imaging modality. CONCLUSION In this largest published group of infants and children diagnosed in primary and emergency care not requiring admission, non-E. coli UTI was not associated with a higher yield from renal tract imaging.
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Affiliation(s)
- Yincent Tse
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK .,Faculty of Medical Science, Newcastle University, Newcastle upon Tyne, UK
| | - Charlie Pickles
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michal Malina
- Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle upon Tyne, UK.,Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Peace
- Department of Nuclear Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Milan Gopal
- Department of Paediatric Urology, Great North Children's Hospital, Newcastle upon Tyne, UK
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Isac R, Basaca DG, Olariu IC, Stroescu RF, Ardelean AM, Steflea RM, Gafencu M, Chirita-Emandi A, Bagiu IC, Horhat FG, Vulcanescu DD, Ionescu D, Doros G. Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract. CHILDREN-BASEL 2021; 8:children8070585. [PMID: 34356564 PMCID: PMC8304885 DOI: 10.3390/children8070585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 01/03/2023]
Abstract
Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.
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Affiliation(s)
- Raluca Isac
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Diana-Georgiana Basaca
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ioana-Cristina Olariu
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ramona F. Stroescu
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
- Ist Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania
| | - Andrada-Mara Ardelean
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Ruxandra M. Steflea
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Mihai Gafencu
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Adela Chirita-Emandi
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
- Department of Microscopic Morphology, Genetics Discipline, Center of Genomic Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Iulia Cristina Bagiu
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (I.C.B.); (F.G.H.)
| | - Florin George Horhat
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Correspondence: (I.C.B.); (F.G.H.)
| | - Dan-Dumitru Vulcanescu
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
| | - Dan Ionescu
- Physical Education and Sports Department, Polytechnic University, 300223 Timișoara, Romania;
| | - Gabriela Doros
- IIIrd Pediatric Clinic, Department of Pediatrics, “Victor Babeș” University of Medicine and Pharmacy Timișoara, 300041 Timișoara, Romania; (R.I.); (I.-C.O.); (A.-M.A.); (R.M.S.); (M.G.); (G.D.)
- Emergency Hospital for Children “Louis Turcanu”, 300011 Timișoara, Romania; (D.-G.B.); (R.F.S.); (A.C.-E.); (D.-D.V.)
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Oliva A, Carmona Y, de La C. López E, Álvarez R, Aung MS, Kobayashi N, Quiñones D. Characterization of Neonatal Infections by Gram-Negative Bacilli and Associated Risk Factors, Havana, Cuba. Infect Dis Rep 2021; 13:219-229. [PMID: 33803222 PMCID: PMC8005978 DOI: 10.3390/idr13010025] [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: 02/18/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022] Open
Abstract
Infections represent an important problem in neonates because of the high mortality. An increase in neonatal infections has been found in Cuban hospitals in recent years. The aim of this study was to provide evidence on the clinical and microbiological behavior of Gram-negative bacilli that cause neonatal infections in hospitals of Havana, Cuba. It was carried out as a descriptive cross-sectional investigation from September 2017 to July 2018 in The Tropical Medicine Institute "Pedro Kouri" (IPK). Sixty-one Gram-negative bacilli isolated from neonates with infections in six Gyneco-Obstetric and Pediatric Hospitals of Havana were analyzed for their species and antimicrobial susceptibility. Late-onset infections were more common than early-onset ones and included urinary tract infection in the community (87%) and sepsis in hospitals (63.3%). Catheter use (47%) and prolonged stay (38%) were the most frequent risk factors. Species of major pathogens were Escherichia coli (47%) and Klebsiella spp. (26%). The isolated Gram-negative bacilli showed high resistance rates to third-generation cephalosporins, ciprofloxacin and gentamicin, while being more susceptible to carbapenems, fosfomycin, colistin and amikacin. The present study revealed the clinical impact of Gram-negative bacilli in neonatology units in hospitals of Havana. Evaluation of antimicrobial susceptibilities to the isolates from neonates is necessary for selection of appropriate empirical therapy and promotion of the rational antibiotic use.
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Affiliation(s)
| | - Yenisel Carmona
- Tropical Medicine Institute “Pedro Kouri”, Havana 11400, Cuba;
| | | | - Roberto Álvarez
- Public Health Ministry, Havana 10400, Cuba; (E.d.L.C.L.); (R.Á.)
| | - Meiji Soe Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (M.S.A.); (N.K.)
| | - Nobumichi Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (M.S.A.); (N.K.)
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