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Alsubaie SS, Barry MA. Current status of long-term antibiotic prophylaxis for urinary tract infections in children: An antibiotic stewardship challenge. Kidney Res Clin Pract 2019; 38:441-454. [PMID: 31739385 PMCID: PMC6913590 DOI: 10.23876/j.krcp.19.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/06/2022] Open
Abstract
Recurrent urinary tract infections (UTIs) in children are associated with development of pyelonephritis and renal scarring. Traditionally, continuous antibiotic prophylaxis (CAP) has been used to prevent recurrent UTI. Recent studies have challenged the efficacy of CAP for preventing renal scarring and have raised concerns about inducing bacterial resistance. This review focuses on studies published between January 2000 and April 2019 and evaluates the use of CAP in children for avoiding recurrent UTIs and renal scarring. A systematic literature search was carried out using the following search terms and related medical subject headings in the MEDLINE electronic database: ‘urinary tract infection’, ‘antimicrobial/antibiotic prophylaxis’, and ‘children/pediatrics’. Randomized clinical trials (RCTs), original research articles, guidelines, systematic reviews, and meta-analyses describing antibiotic prophylaxis for UTIs were included. A total of 34 RCTs, 9 systematic reviews, and 3 guidelines describing antibiotic prophylaxis were included in this review. The efficacy of CAP for preventing recurrent UTI remains unclear due to non-generalizability of results obtained from suboptimally designed clinical trials. CAP has not been proven as beneficial for preventing new renal scarring in children. Additionally, CAP is associated with increased risk of multidrug resistant infections in children. No conclusive evidence can be drawn from the available clinical data to support routine use of CAP for prevention of renal scarring. Accumulation of evidence from additional well designed studies may result in different conclusions in the future. It is important to identify specific risks for recurrent UTI and ensuing renal injury to ensure more judicious use of CAP.
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Affiliation(s)
- Sarah S Alsubaie
- Pediatric Infectious Diseases Unit, Department of Pediatrics, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mazin A Barry
- Infectious Diseases Unit, Department of Internal Medicine, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
Reconstructive urologists are constantly facing diverse and complex pathologies that require structural and functional restoration of urinary organs. There is always a demand for a biocompatible material to repair or substitute the urinary tract instead of using patient's autologous tissues with its associated morbidity. Biomimetic approaches are tissue-engineering tactics aiming to tailor the material physical and biological properties to behave physiologically similar to the urinary system. This review highlights the different strategies to mimic urinary tissues including modifications in structure, surface chemistry, and cellular response of a range of biological and synthetic materials. The article also outlines the measures to minimize infectious complications, which might lead to graft failure. Relevant experimental and preclinical studies are discussed, as well as promising biomimetic approaches such as three-dimensional bioprinting.
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Affiliation(s)
- Moustafa M Elsawy
- Division of Surgery and Interventional Science, Royal Free Hospital, NHS Trust, University College London (UCL)
- Division of Reconstructive Urology, University College London Hospitals (uclh), London, UK
- Urology Department, School of Medicine, Alexandria University, Alexandria, Egypt
| | - Achala de Mel
- Division of Surgery and Interventional Science, Royal Free Hospital, NHS Trust, University College London (UCL)
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Gökçe İ, Çiçek N, Güven S, Altuntaş Ü, Bıyıklı N, Yıldız N, Alpay H. Changes in Bacterial Resistance Patterns of Pediatric Urinary Tract Infections and Rationale for Empirical Antibiotic Therapy. Balkan Med J 2017; 34:432-435. [PMID: 28443576 PMCID: PMC5635630 DOI: 10.4274/balkanmedj.2015.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: The causative agent spectrum and resistance patterns of urinary tract infections in children are affected by many factors. Aims: To demonstrate antibiotic resistance in urinary tract infections and changing ratio in antibiotic resistance by years. Study Design: Retrospective cross-sectional study. Methods: We analysed antibiotic resistance patterns of isolated Gram (-) bacteria during the years 2011-2014 (study period 2) in children with urinary tract infections. We compared these findings with data collected in the same centre in 2001-2003 (study period 1. Results: Four hundred and sixty-five uncomplicated community-acquired Gram (-) urinary tract infections were analysed from 2001-2003 and 400 from 2011-2014. Sixty-one percent of patients were female (1.5 girls : 1 boy). The mean age of children included in the study was 3 years and 9 months. Escherichia coli was the predominant bacteria isolated during both periods of the study (60% in study period 1 and 73% in study period 2). Bacteria other than E. coli demonstrated a higher level of resistance to all of the antimicrobials except trimethoprim-sulfamethoxazole than E. coli bacteria during the years 2011-2014. In our study, we found increasing resistance trends of urinary pathogens for cefixime (from 1% to 15%, p<0.05), amikacin (from 0% to 4%, p<0.05) and ciprofloxacin (from 0% to 3%, p<0.05) between the two periods. Urinary pathogens showed a decreasing trend for nitrofurantoin (from 17% to 7%, p=0.0001). No significant trends were detected for ampicillin (from 69% to 71%), amoxicillin-clavulanate (from 44% to 43%), cefazolin (from 39% to 32%), trimethoprim-sulfamethoxazole (from 32% to 31%), cefuroxime (from 21% to 18%) and ceftriaxone (from 10% to 14%) between the two periods (p>0.05). Conclusion: In childhood urinary tract infections, antibiotic resistance should be evaluated periodically and empiric antimicrobial therapy should be decided according to antibiotic sensitivity results.
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Affiliation(s)
- İbrahim Gökçe
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
| | - Neslihan Çiçek
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
| | - Serçin Güven
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
| | - Ülger Altuntaş
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
| | - Neşe Bıyıklı
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
| | - Nurdan Yıldız
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
| | - Harika Alpay
- Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
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Karimian M, Kermani R, Khaleghi M, Kelishadi R, Ataei B, Mostafavi N. Antibiotic susceptibility patterns of isolates from children with urinary tract infection in Isfahan, Iran: Impact on empirical treatment. J Glob Antimicrob Resist 2017; 9:3-7. [PMID: 28232229 DOI: 10.1016/j.jgar.2016.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/09/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify the antibiotic susceptibility of bacteria causing urinary tract infections (UTIs) in children in Isfahan, Iran. METHODS Retrospective and prospective analyses were conducted on isolates from children with UTIs in a referral teaching hospital of Isfahan during 2013-2015. Findings were compared between first episode versus recurrent, nosocomial versus community-acquired, previous antibiotic use versus no previous antibiotic use, and febrile versus afebrile cases. RESULTS Among 364 patients, 68.1% had no previous UTI, 19.7% has received antibiotics prior to infection and 96.2% were infected outside the hospital. Escherichia coli was the leading cause of UTI (68.1%), followed by Enterobacter (9.3%), Klebsiella (8.8%) and other bacteria (13.7%). Most isolates were relatively highly susceptible to imipenem (79.2%), ciprofloxacin (78.0%) and nitrofurantoin (70.8%), whereas sensitivity to cefotaxime (53%), cefalexin (39.8%) and trimethoprim/sulfamethoxazole (SXT) (26.1%) was low. Resistance to imipenem, cefotaxime and cefalexin was more prevalent in recurrent cases as well as in patients consuming antibiotics prior to UTI. Resistance of nosocomial cases to nitrofurantoin and cefotaxime was higher. In addition, afebrile patients had isolates that were more resistant to imipenem, ciprofloxacin and cefotaxime. Significant cross-resistance was found between most of the studied antibiotics. CONCLUSIONS Urinary pathogens showed low susceptibility to cefalexin, SXT and cefotaxime and high susceptibility to imipenem, ciprofloxacin and nitrofurantoin. Therefore, use of imipenem and ciprofloxacin should be considered in hospitalised children with severe or complicated disease. In addition, nitrofurantoin is a good option in afebrile cases and for UTI chemoprophylaxis in this area.
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Affiliation(s)
- Mahnaz Karimian
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasoul Kermani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Moj Khaleghi
- Department of Biology, Faculty of Science, Shahid Bahonar University of Sciences, Kerman, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasser Mostafavi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Stultz JS, Doern CD, Godbout E. Antibiotic Resistance in Pediatric Urinary Tract Infections. Curr Infect Dis Rep 2016; 18:40. [PMID: 27761778 DOI: 10.1007/s11908-016-0555-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Urinary tract infections (UTIs) are a common problem in pediatric patients. Resistance to common antibiotic agents appears to be increasing over time, although resistance rates may vary based on geographic region or country. Prior antibiotic exposure is a pertinent risk factor for acquiring resistant organisms during a first UTI and recurrent UTI. Judicious prescribing of antibiotics for common pediatric conditions is needed to prevent additional resistance from occurring. Complex pediatric patients with histories of hospitalizations, prior antibiotic exposure, and recurrent UTIs are also at high risk for acquiring UTIs due to extended spectrum beta-lactamase-producing organisms. Data regarding the impact of in vitro antibiotic susceptibility testing interpretation on UTI treatment outcomes is lacking.
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Affiliation(s)
- Jeremy S Stultz
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Smith Building, Room 435, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298, USA.
| | - Christopher D Doern
- Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA, 23298, USA
| | - Emily Godbout
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, 23298, USA
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Fidan K, Büyükkaragöz B, Özen O, Demirogullari B, Söylemezoglu O. The use of intravesical hyaluronic acid for recurrent urinary tract infections in children: a case-series study. Ren Fail 2015; 37:354-8. [PMID: 26375508 DOI: 10.3109/0886022x.2015.1087863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This is the first study performed to evaluate the effects of intravesical hyaluronic acid (IHA) instillation on diminishing the frequency of recurrent urinary tract infections (UTIs) in children. METHODS Fifteen children (10 girls, 5 boys) with recurrent UTIs were divided into two groups as either complicated (group 1) (with accompanying disorders including vesicoureteral reflux or neurogenic bladder) or uncomplicated patients (group 2). After administration of weekly four sessions of IHA therapy the patients were followed-up monthly for 2 years and classified as responsive (complete/partial) or unresponsive to treatment. RESULTS 53.3% of the patients with recurrent UTIs were complicated. In group 1 (n = 8), complete and partial response rates were 62.5% (n = 5) and 25% (n = 2), respectively. There was no response in 12.5% (n = 1) of the cases in group 1. In group 2 (n = 7), complete and partial response rates were 71.4% (n = 5) and 14.3% (n = 1), respectively. In this group, 14.3% (n = 1) of the patients were found to be unresponsive to IHA treatment. No side effects were observed in any of the patients. CONCLUSIONS IHA administration is considered as an effective treatment modality which significantly reduces the prevalence of or even provides complete recovery from recurrent UTIs in childhood. Therefore, it is believed that this approach can be used as a promising alternative to widespread use of antibiotics in this patient group.
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Affiliation(s)
- Kibriya Fidan
- a Division of Pediatric Nephrology , Gazi University , Ankara , Turkey and
| | - Bahar Büyükkaragöz
- a Division of Pediatric Nephrology , Gazi University , Ankara , Turkey and
| | - Onur Özen
- b Division of Pediatric Surgery , Gazi University , Ankara , Turkey
| | | | - Oguz Söylemezoglu
- a Division of Pediatric Nephrology , Gazi University , Ankara , Turkey and
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Abstract
ABSTRACT
Antimicrobial agents of various types have important bearing on the outcomes of microbial infections. These agents may be bacteriostatic or –cidal, exert their impact via various means, originate from a living organism or a laboratory, and appropriately be used in or on living tissue or not. Though the primary focus of this chapter is on resistance to the antimicrobial agents used to treat uropathogenic
Escherichia coli
(UPEC)-caused urinary tract infections (UTIs), some attention will be given to UPEC’s resistance to silver-containing antiseptics, which may be incorporated into catheters to prevent foreign body-associated UTIs.
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Anago E, Ayi-Fanou L, Akpovi CD, Hounkpe WB, Agassounon-Djikpo Tchibozo M, Bankole HS, Sanni A. Antibiotic resistance and genotype of beta-lactamase producing Escherichia coli in nosocomial infections in Cotonou, Benin. Ann Clin Microbiol Antimicrob 2015; 14:5. [PMID: 25595314 PMCID: PMC4304606 DOI: 10.1186/s12941-014-0061-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Beta lactams are the most commonly used group of antimicrobials worldwide. The presence of extended-spectrum lactamases (ESBL) affects significantly the treatment of infections due to multidrug resistant strains of gram-negative bacilli. The aim of this study was to characterize the beta-lactamase resistance genes in Escherichia coli isolated from nosocomial infections in Cotonou, Benin. Methods Escherichia coli strains were isolated from various biological samples such as urine, pus, vaginal swab, sperm, blood, spinal fluid and catheter. Isolated bacteria were submitted to eleven usual antibiotics, using disc diffusion method according to NCCLS criteria, for resistance analysis. Beta-lactamase production was determined by an acidimetric method with benzylpenicillin. Microbiological characterization of ESBL enzymes was done by double disc synergy test and the resistance genes TEM and SHV were screened by specific PCR. Results ESBL phenotype was detected in 29 isolates (35.5%). The most active antibiotic was imipenem (96.4% as susceptibility rate) followed by ceftriaxone (58.3%) and gentamicin (54.8%). High resistance rates were observed with amoxicillin (92.8%), ampicillin (94%) and trimethoprim/sulfamethoxazole (85.7%). The genotype TEM was predominant in ESBL and non ESBL isolates with respectively 72.4% and 80%. SHV-type beta-lactamase genes occurred in 24.1% ESBL strains and in 18.1% of non ESBL isolates. Conclusion This study revealed the presence of ESBL producing Eschericiha coli in Cotonou. It demonstrated also high resistance rate to antibiotics commonly used for infections treatment. Continuous monitoring and judicious antibiotic usage are required.
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Affiliation(s)
- Eugénie Anago
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin. .,Laboratoire de Recherche en Biologie Appliquée (LARBA), Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, B.P. 2009, Cotonou, Bénin.
| | - Lucie Ayi-Fanou
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin.
| | - Casimir D Akpovi
- Laboratoire de Recherche en Biologie Appliquée (LARBA), Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, B.P. 2009, Cotonou, Bénin.
| | - Wilfried B Hounkpe
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin.
| | - Micheline Agassounon-Djikpo Tchibozo
- Laboratoire de Génétique et des Biotechnologies, Faculté des Sciences et Techniques (FAST), Université d'Abomey-Calavi (UAC), 01 BP 1636 RP, Cotonou, Bénin.
| | - Honoré S Bankole
- Laboratoire de Recherche en Biologie Appliquée (LARBA), Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, B.P. 2009, Cotonou, Bénin.
| | - Ambaliou Sanni
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin.
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Saperston KN, Shapiro DJ, Hersh AL, Copp HL. A comparison of inpatient versus outpatient resistance patterns of pediatric urinary tract infection. J Urol 2014; 191:1608-13. [PMID: 24679887 DOI: 10.1016/j.juro.2013.10.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Prior single center studies showed that antibiotic resistance patterns differ between outpatients and inpatients. We compared antibiotic resistance patterns for urinary tract infection between outpatients and inpatients on a national level. MATERIALS AND METHODS We examined outpatient and inpatient urinary isolates from children younger than 18 years using The Surveillance Network (Eurofins Scientific, Luxembourg, Luxembourg), a database of antibiotic susceptibility results, as well as patient demographic data from 195 American hospitals. We determined the prevalence and antibiotic resistance patterns of the 6 most common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for outpatient and inpatient isolates using chi-square analysis. RESULTS We identified 25,418 outpatient (86% female) and 5,560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall but its prevalence varied by gender and visit setting, that is 79% of uropathogens overall for outpatient isolates, including 83% of females and 50% of males, compared to 54% for overall inpatient isolates, including 64% of females and 37% of males (p <0.001). Uropathogen resistance to many antibiotics was lower in the outpatient vs inpatient setting, including trimethoprim/sulfamethoxazole 24% vs 30% and cephalothin 16% vs 22% for E. coli (each p <0.001), cephalothin 7% vs 14% for Klebsiella (p = 0.03), ceftriaxone 12% vs 24% and ceftazidime 15% vs 33% for Enterobacter (each p <0.001), and ampicillin 3% vs 13% and ciprofloxacin 5% vs 12% for Enterococcus (each p <0.001). CONCLUSIONS Uropathogen resistance rates of several antibiotics are higher for urinary specimens obtained from inpatients vs outpatients. Separate outpatient vs inpatient based antibiograms can aid in empirical prescribing for pediatric urinary tract infections.
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Affiliation(s)
- Kara N Saperston
- University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah
| | - Daniel J Shapiro
- University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah
| | - Adam L Hersh
- University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah
| | - Hillary L Copp
- University of California-San Francisco, San Francisco, California; University of Utah (ALH), Salt Lake City, Utah
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Jerardi KE, Auger KA, Shah SS, Hall M, Hain PD, Myers AL, Williams DJ, Tieder JS. Discordant antibiotic therapy and length of stay in children hospitalized for urinary tract infection. J Hosp Med 2012; 7:622-7. [PMID: 22833498 DOI: 10.1002/jhm.1960] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/31/2012] [Accepted: 06/15/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are a common reason for pediatric hospitalizations. OBJECTIVE To determine the effect of discordant antibiotic therapy (in vitro nonsusceptibility of the uropathogen to initial antibiotic) on clinical outcomes for children hospitalized for UTI. DESIGN/SETTING Multicenter retrospective cohort study in children aged 3 days to 18 years, hospitalized at 5 children's hospitals with a laboratory-confirmed UTI. Data were obtained from medical records and the Pediatric Hospital Information System (PHIS) database. PARTICIPANTS Patients with laboratory-confirmed UTI. MAIN EXPOSURE Discordant antibiotic therapy. MEASUREMENTS Length of stay and fever duration. Covariates included age, sex, insurance, race, vesicoureteral reflux, antibiotic prophylaxis, genitourinary abnormality, and chronic care conditions. RESULTS The median age of the 216 patients was 2.46 years (interquartile range [IQR]: 0.27, 8.89) and 25% were male. The most common causative organisms were E. coli and Klebsiella species. Discordant therapy occurred in 10% of cases and most commonly in cultures positive for Klebsiella species, Enterobacter species, and mixed organisms. In adjusted analyses, discordant therapy was associated with a 1.8 day (95% confidence interval [CI]: 1.5, 2.1) longer length of stay [LOS], but not with fever duration. CONCLUSIONS Discordant antibiotic therapy for UTI is common and associated with longer hospitalizations. Further research is needed to understand the clinical factors contributing to the increased LOS and to inform decisions for empiric antibiotic selection in children with UTIs.
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Affiliation(s)
- Karen E Jerardi
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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