| Abstract |
Urinary tract infections (UTI) are among the most common bacterial infections in childhood. Antibiotics are a mainstay in the treatment of bacterial infections, however their use is suggested to be a primary risk factor for the development of antibiotic re-sistance. Antimicrobial resistance is a well-recognized threat to public health and an increasing problem in pediatric urology. The overuse of antibiotics in children seems to be related with an increased risk of uropathogen resistance, which could limit the effectiveness of antimicrobial agents. The relationship between antimicrobial use and resistance patterns and types of uropathogens, has not been extensively investigated in children.
Objective: The aim of this study was to investigate the impact of previous antibiotic exposure on the development of unusual and resistant bacterial pathogens in children with UTI.
Methods: A retrospective observational study was conducted, involving children aged <16 years who were hospitalized for UTI in a tertiary center, during the 11-year period from January 2007 to June 2017. The medical records of all included children were reviewed and demographic data, previous antibiotic use, underlying conditions, uropathogens and their antibiotic susceptibility and imaging were recorded. Subse-quently, patients were divided into 3 groups, children who were not exposed to antibi-otics, children who received a short antibiotic regimen in the previous 6 months and children who were on prophylaxis. The 3 groups were investigated for differences in types of uropathogens and resistance patterns with the use of appropriate statistical
Vaccines and Prevention of Infectious Diseases in Childhood and Adolescence
Faculty of Medicine – University of Crete
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methods. All analyses were conducted with MedCalc and GraphPad Prism statistical programs.
Results: A total of 711 uropathogens were identified from children with UTI. E. coli was the most common pathogen (56.4%) followed by Klebsiella spp (10.8%) and En-terococcus spp (9.8%). Non-E. coli pathogens were more common in children receiv-ing prophylaxis (69.8%) and in those with history of previous antibiotic exposure (51.2%). E. Coli resistance rates were highest for ampicillin (52.3%), amoxicillin (50.5%) amoxicillin-clavulanate (23.1%) and cotrimoxazole (21.7%), and lowest for third generation cephalosporins (7.2%) and nitrofurantoin (10%). Overall, resistance was significantly lower in children who were not exposed to antimicrobial agents. Re-sistance rates of all uropathogens and in all groups, were highest for ampicillin, amox-icillin, amoxicillin/clavulanate, cotrimoxazole and nitrofurantoin (p<0.0001). Lower resistance was observed for second and third generation cephalosporins (p<0.0001). Univariate analysis showed a statistically significant association between prior antibi-otic exposure and occurrence of unusual uropathogens (p<0.0001). Additionally, mul-tivariate logistic regression analysis revealed that consumption of antibiotics in the previous 6 months was a major risk factor for E. coli resistant to ampicillin (OR 2.64, 95% CI 1.47 - 4.75, p 0.0011) whereas use of prophylaxis was a major risk factor for E. coli resistant to cotrimoxazole (OR 2.69, 95% CI 1.31-5.52 p 0.0066). Also, gender appeared to be an important risk factor for non-E. coli UTI.
Conclusions: Our findings underline the significant impact of previous antimicrobial exposure on the development of antimicrobial resistance among uropathogens in chil-dren, even in cases of short antibiotic regime for common infections. Local antimi-crobial resistance patterns and history of previous antibiotic exposure, particularly within the last six months should be taken into account in selecting empirical antibi-otic treatment for children with UTIs.
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Επίδραση της χημειοπροφύλαξης στο είδος και την αντοχή των ουροπαθογόνων στα παιδιά
