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Changes in bacterial resistance patterns in children with urinary tract infections on antimicrobial prophylaxis at University Hospital in Split.

Ilić T, Gračan S, Arapović A, Capkun V, Subat-Dežulović M, Saraga M - Med. Sci. Monit. (2011)

Bottom Line: Both groups displayed significantly less resistance of Enterococcus sp.In patients receiving LTAP before hospitalization, E. coli was significantly more resistant to ampicillin, amoxicillin/clavulonic acid and TMP/SMX than in those without LTAP.Based on our results, we recommend excluding ampicillin altogether, and reconsideration of further use of TMP-SMX, as well as use of nitrofurantoin, cephalexin and amoxicillin/clavulonic acid for LTAP in our region.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, University of Split, Split, Croatia.

ABSTRACT

Background: We assessed prevalence and resistance of uropathogens on antimicrobial agents (AA) from urine cultures (UC) in children hospitalized with urinary tract infections (UTI) at University Hospital in Split.

Material/methods: During the 7-year period, children hospitalized only once with UTI alone were compared to those repeatedly hospitalized, and who received long-term antimicrobial prophylaxis (LTAP), as well as those with associated anomalies of the urinary system (US).

Results: E. coli was the most frequent isolate (67.7%) with resistance to ampicillin by 69.5%, amoxicillin/clavulonic acid by 3.5%, cephalexin by 6.6%, trimethoprim/sulfamethoxazole (TMP-SMX) by 27.5%, and nitrofurantoin by 0.4%. For other uropathogens, AA resistance rates were the following: 64.3%, 5.8%, 10.5%, 21.3%, and 7.9%. The high or increasing resistance to TMP-SMX is characterized by all uropathogens. Patients with anomalies of US showed a lower prevalence of E. coli and Enterococcus sp., but a higher prevalence of Pseudomonas sp., ESBL-producing E. coli and Klebsiella sp. than those without US anomalies. Repeatedly hospitalized patients showed a lower prevalence of E. coli, but a higher prevalence of Pseudomonas sp. and Klebsiella sp. than patients hospitalized only once. Both groups displayed significantly less resistance of Enterococcus sp. In patients receiving LTAP before hospitalization, E. coli was significantly more resistant to ampicillin, amoxicillin/clavulonic acid and TMP/SMX than in those without LTAP.

Conclusions: Based on our results, we recommend excluding ampicillin altogether, and reconsideration of further use of TMP-SMX, as well as use of nitrofurantoin, cephalexin and amoxicillin/clavulonic acid for LTAP in our region.

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This figure shows that resistant rates of E. coli to various uroantiseptic drugs were the highest for ampicillin and TMP/SMX. During the period of observance E. coli’s resistance to TMP/SMX had significantly increasing trend, to cephalexin had significantly decreasing trend while to amoxicillin/clavulonic acid had 93% probability to have decreasing trend. Resistance rates of E. coli did not change significantly to ampicillin and to nitrofurantoin during the period of observance. Spearman’s correlation coefficient (ρ) and χ2 (p) were as follows: to ampicillin (ρ=−0.120; p=0.776), to TMP/SMX (ρ=0.762; p=0.028), to cephalexin (ρ=−0.786; p=0.021), amoxicillin/clavulonic acid (ρ=−0.66; p=0.075), and to nitrofurantoin (ρ=−0.192; p=0.648).
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f1-medscimonit-17-7-cr355: This figure shows that resistant rates of E. coli to various uroantiseptic drugs were the highest for ampicillin and TMP/SMX. During the period of observance E. coli’s resistance to TMP/SMX had significantly increasing trend, to cephalexin had significantly decreasing trend while to amoxicillin/clavulonic acid had 93% probability to have decreasing trend. Resistance rates of E. coli did not change significantly to ampicillin and to nitrofurantoin during the period of observance. Spearman’s correlation coefficient (ρ) and χ2 (p) were as follows: to ampicillin (ρ=−0.120; p=0.776), to TMP/SMX (ρ=0.762; p=0.028), to cephalexin (ρ=−0.786; p=0.021), amoxicillin/clavulonic acid (ρ=−0.66; p=0.075), and to nitrofurantoin (ρ=−0.192; p=0.648).

Mentions: The mean resistance rates of the most prevalent E. coli were as follows: 69.5% to ampicillin, 3.5% to amoxicillin/clavulonic acid, 6.6% to cephalexin, 27.5% to TMP/SMX, and 0.4% to nitrofurantoin. During the study period, follow-up of the trends in resistance rates of E. coli to antimicrobial agents disclosed a statisticaly significant positive trend to TMP/SMX (ρ=0.762; P=0.028), a statisticaly significant negative trend to cephalexin (ρ=−0.786; P=0.021), while no significant trends were detected to ampicillin (ρ=−0.120; P=0.776) and nitrofurantoin (r=−0.192; p=0.648). We also proved 93% probability of a negative trend in the resistance rate of E. coli to amoxicillin/clavulonic acid (r=−0.66; P=0.075) during the study period (Figure 1).


Changes in bacterial resistance patterns in children with urinary tract infections on antimicrobial prophylaxis at University Hospital in Split.

Ilić T, Gračan S, Arapović A, Capkun V, Subat-Dežulović M, Saraga M - Med. Sci. Monit. (2011)

This figure shows that resistant rates of E. coli to various uroantiseptic drugs were the highest for ampicillin and TMP/SMX. During the period of observance E. coli’s resistance to TMP/SMX had significantly increasing trend, to cephalexin had significantly decreasing trend while to amoxicillin/clavulonic acid had 93% probability to have decreasing trend. Resistance rates of E. coli did not change significantly to ampicillin and to nitrofurantoin during the period of observance. Spearman’s correlation coefficient (ρ) and χ2 (p) were as follows: to ampicillin (ρ=−0.120; p=0.776), to TMP/SMX (ρ=0.762; p=0.028), to cephalexin (ρ=−0.786; p=0.021), amoxicillin/clavulonic acid (ρ=−0.66; p=0.075), and to nitrofurantoin (ρ=−0.192; p=0.648).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539571&req=5

f1-medscimonit-17-7-cr355: This figure shows that resistant rates of E. coli to various uroantiseptic drugs were the highest for ampicillin and TMP/SMX. During the period of observance E. coli’s resistance to TMP/SMX had significantly increasing trend, to cephalexin had significantly decreasing trend while to amoxicillin/clavulonic acid had 93% probability to have decreasing trend. Resistance rates of E. coli did not change significantly to ampicillin and to nitrofurantoin during the period of observance. Spearman’s correlation coefficient (ρ) and χ2 (p) were as follows: to ampicillin (ρ=−0.120; p=0.776), to TMP/SMX (ρ=0.762; p=0.028), to cephalexin (ρ=−0.786; p=0.021), amoxicillin/clavulonic acid (ρ=−0.66; p=0.075), and to nitrofurantoin (ρ=−0.192; p=0.648).
Mentions: The mean resistance rates of the most prevalent E. coli were as follows: 69.5% to ampicillin, 3.5% to amoxicillin/clavulonic acid, 6.6% to cephalexin, 27.5% to TMP/SMX, and 0.4% to nitrofurantoin. During the study period, follow-up of the trends in resistance rates of E. coli to antimicrobial agents disclosed a statisticaly significant positive trend to TMP/SMX (ρ=0.762; P=0.028), a statisticaly significant negative trend to cephalexin (ρ=−0.786; P=0.021), while no significant trends were detected to ampicillin (ρ=−0.120; P=0.776) and nitrofurantoin (r=−0.192; p=0.648). We also proved 93% probability of a negative trend in the resistance rate of E. coli to amoxicillin/clavulonic acid (r=−0.66; P=0.075) during the study period (Figure 1).

Bottom Line: Both groups displayed significantly less resistance of Enterococcus sp.In patients receiving LTAP before hospitalization, E. coli was significantly more resistant to ampicillin, amoxicillin/clavulonic acid and TMP/SMX than in those without LTAP.Based on our results, we recommend excluding ampicillin altogether, and reconsideration of further use of TMP-SMX, as well as use of nitrofurantoin, cephalexin and amoxicillin/clavulonic acid for LTAP in our region.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine, University of Split, Split, Croatia.

ABSTRACT

Background: We assessed prevalence and resistance of uropathogens on antimicrobial agents (AA) from urine cultures (UC) in children hospitalized with urinary tract infections (UTI) at University Hospital in Split.

Material/methods: During the 7-year period, children hospitalized only once with UTI alone were compared to those repeatedly hospitalized, and who received long-term antimicrobial prophylaxis (LTAP), as well as those with associated anomalies of the urinary system (US).

Results: E. coli was the most frequent isolate (67.7%) with resistance to ampicillin by 69.5%, amoxicillin/clavulonic acid by 3.5%, cephalexin by 6.6%, trimethoprim/sulfamethoxazole (TMP-SMX) by 27.5%, and nitrofurantoin by 0.4%. For other uropathogens, AA resistance rates were the following: 64.3%, 5.8%, 10.5%, 21.3%, and 7.9%. The high or increasing resistance to TMP-SMX is characterized by all uropathogens. Patients with anomalies of US showed a lower prevalence of E. coli and Enterococcus sp., but a higher prevalence of Pseudomonas sp., ESBL-producing E. coli and Klebsiella sp. than those without US anomalies. Repeatedly hospitalized patients showed a lower prevalence of E. coli, but a higher prevalence of Pseudomonas sp. and Klebsiella sp. than patients hospitalized only once. Both groups displayed significantly less resistance of Enterococcus sp. In patients receiving LTAP before hospitalization, E. coli was significantly more resistant to ampicillin, amoxicillin/clavulonic acid and TMP/SMX than in those without LTAP.

Conclusions: Based on our results, we recommend excluding ampicillin altogether, and reconsideration of further use of TMP-SMX, as well as use of nitrofurantoin, cephalexin and amoxicillin/clavulonic acid for LTAP in our region.

Show MeSH
Related in: MedlinePlus