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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 significantly higher prevalence of Pseudomonas sp. and significantly lower prevalence of Enterococcus sp. in patients with functional or anatomic anomalies of urinary system.
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getmorefigures.php?uid=PMC3539571&req=5

f2-medscimonit-17-7-cr355: This figure shows significantly higher prevalence of Pseudomonas sp. and significantly lower prevalence of Enterococcus sp. in patients with functional or anatomic anomalies of urinary system.

Mentions: Among the group of 324 children with functional or anatomic abnormalities, there were 27 cases of functional anomalies of the lower urinary system, 47 cases of hydronephrosis, 35 cases of duplex collecting system, 11 cases of urolithiasis, 116 cases of vesico ureteral reflux, and 29 cases of other anatomic anomalies of the urinary system. Fifty-nine patients underwent surgery on the urinary system. Pseudomonas was 3 times more common while Enterococcus was 2 times less common in patients with functional or anatomic anomalies of the urinary system than in patients with normal urinary systems (Figure 2).


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 significantly higher prevalence of Pseudomonas sp. and significantly lower prevalence of Enterococcus sp. in patients with functional or anatomic anomalies of urinary system.
© Copyright Policy
Related In: Results  -  Collection

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

f2-medscimonit-17-7-cr355: This figure shows significantly higher prevalence of Pseudomonas sp. and significantly lower prevalence of Enterococcus sp. in patients with functional or anatomic anomalies of urinary system.
Mentions: Among the group of 324 children with functional or anatomic abnormalities, there were 27 cases of functional anomalies of the lower urinary system, 47 cases of hydronephrosis, 35 cases of duplex collecting system, 11 cases of urolithiasis, 116 cases of vesico ureteral reflux, and 29 cases of other anatomic anomalies of the urinary system. Fifty-nine patients underwent surgery on the urinary system. Pseudomonas was 3 times more common while Enterococcus was 2 times less common in patients with functional or anatomic anomalies of the urinary system than in patients with normal urinary systems (Figure 2).

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