Korean J Pediatr.  2009 Oct;52(10):1147-1152. 10.3345/kjp.2009.52.10.1147.

Microbiological spectrum and antibiotic susceptibility pattern in more than 24-month-old children with urinary tract infection: A6-year retrospective, single center experience

• Ko JH
• Lee JH
• Shim EJ
• Cho DJ
• Min KS
• Yoo KY
• Lee DH
• Kang HJ

• KMID: 2281055
• DOI: http://doi.org/10.3345/kjp.2009.52.10.1147

Abstract

PURPOSE
To characterize the pathogens and their antibiotic susceptibilities in more than 24-month-old children with urinary tract infection (UTI) and to study the Escherichia coli antimicrobial susceptibility trend.
METHODS
We retrospectively reviewed the record of more than 24-month-old children with UTI between January 2003 and December 2008. Positive results for 1 bacterial species with a colony count of > or =10(5) CFU/mL was considered statistically significant. We analyzed uropathogens and their antibiotic susceptibilities. To investigate E. coli antibiotic susceptibility trend, we compared 2 study periods (group A: 2003-2005 versus group B: 2006-2008) using the chi-square test for trend.
RESULTS
In all, 63 bacterial isolates were identified in children with febrile UTI. The most common pathogen was E. coli (77.8%). There was no difference in the resistance patterns of uropathogens during the 2 study periods (P>0.05). Antibiotic susceptibility of the E. coli isolates to aztreonam, cefotetan, cefotaxime, ceftriaxone, cefepime, amikacin, and imipenem was >90% to trimethoprim/sulfamethoxazol, 49% and to ampicillin and ampicillin/sulbactam, 20-25%. Over the 2 study period, the E. coli susceptibilities to most antibiotics did not change: the susceptibility to cefuroxime increased from 74.1% to 95.5% (P=0.046) and that to ciprofloxacin increased from 59.3% to 86.4% (P=0.039).
CONCLUSION
Empirical treatment with trimethoprim/sulfamethoxazole, ampicillin, and ampicillin/sulbactam alone appeared to be insufficient in childhood UTI because of the high resistance of E. coli and other gram-negative uropathogens. Antibiotics for empirical therapy should be selected based on the sensitivity and resistance pattern of uropathogens found in a particular region.

Keyword

Urinary tract infection; Children; Antibiotic resistance

MeSH Terms

Amikacin
Ampicillin
Anti-Bacterial Agents
Aztreonam
Cefotaxime
Cefotetan
Ceftriaxone
Cefuroxime
Cephalosporins
Child
Ciprofloxacin
Drug Resistance, Microbial
Escherichia coli
Humans
Imipenem
Preschool Child
Retrospective Studies
Urinary Tract
Urinary Tract Infections
Amikacin
Ampicillin
Anti-Bacterial Agents
Aztreonam
Cefotaxime
Cefotetan
Ceftriaxone
Cefuroxime
Cephalosporins
Ciprofloxacin
Imipenem