Browse > Article
http://dx.doi.org/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, Jeong Hee (Departments of Pediatrics, College of Medicine, Hallym University)
Lee, Jee Hyun (Departments of Pediatrics, College of Medicine, Hallym University)
Sim, Eun Jung (Departments of Pediatrics, College of Medicine, Hallym University)
Cho, Do Jun (Departments of Pediatrics, College of Medicine, Hallym University)
Min, Ki Sik (Departments of Pediatrics, College of Medicine, Hallym University)
Yoo, Ki Yang (Departments of Pediatrics, College of Medicine, Hallym University)
Lee, Dae Hyoung (Departments of Pediatrics, College of Medicine, Hallym University)
Kang, Hee Jung (Departments of Laboratory Medicine, College of Medicine, Hallym University)
Publication Information
Clinical and Experimental Pediatrics / v.52, no.10, 2009 , pp. 1147-1152 More about this Journal
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 ${\geq}10^5CFU/mL$ 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.
Keywords
Urinary tract infection; Children; Antibiotic resistance;
Citations & Related Records
Times Cited By KSCI : 7  (Citation Analysis)
연도 인용수 순위
1 Kim NH, Lee JA, Kim YK, Choi EH, Ha IS, Lee HJ, et al. Risk factors of urinary tract infections due to extended- spectrum beta-lactamase producing Escherichia coli in children. Korean J Pediatr 2004;47:164-9
2 Jung HJ, Aum JA, Jung SJ, Huh JW. Different characteristic between Escherichia coli and non-Escherichea coli urinary tract infection. Korean J Pediatr 2007;50:457-61   DOI   ScienceOn
3 Marcus N, Ashkenazi S, Yaari A, Samra Z, Livni G. Non- Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: Relative frequency, risk factors, antimicrobial resistance and outcome. Pediatr Infect Dis J 2005;24:581-5   DOI   ScienceOn
4 Sharifian M, Karimi A, Tabatabaei SR, Anvaripour N. Microbial sensitivity pattern in urinary tract infections in children: A single center experience of 1,177 urine cultures. Jpn J Infect Dis 2006;59:380-2   PUBMED   ScienceOn
5 Abelson Storby K, Osterlund A, Kahlmeter G. Antimicrobial resistance in Escherichia coli in urine samples from children and adults: A 12 year analysis. Acta Paediatr 2004;93:487-91   DOI   ScienceOn
6 American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843-52   DOI   PUBMED
7 Gaspari RJ, Dickson E, Karlowsky J, Doern G. Antibiotic resistance trends in paediatric uropathogens. Int J Antimicrob Agents 2005;26:267-71   DOI   ScienceOn
8 Elder JS. Urinary tract infections. In : Kliegman RM, Behrman RE, Jensen HB, Stanton BF, editors. Nelson textbook of pediatrics, 18th ed. Philadelphia: WB Saunders Co, 2007:2223-8
9 Lee JW, Shin JS, Seo JW, Lee MA, Lee SJ. Incidence and risk factors for extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired childhood urinary tract infection. J Korean Soc Pediatr Nephrol 2004;8:214-22
10 Kang MJ, Shin HK, Yim HE, Je BK, Eun SH, Choi BM, et al. Urinary tract infections in infants under six months of age. Korean J Pediatr 2006;49:278-86   DOI
11 Bronzwaer SL, Cars O, Buchholz U, Molstad S, Goettsch W, Veldhuijzen IK, et al. A European study on the relationship between antimicrobial use and antimicrobial resistance. Emerg Infect Dis 2002;8:278-82   DOI   ScienceOn
12 Chi HM, Kwahk JH, Lee JH, Park HW. Incidence of Escherichia coli and its susceptibility to antimicrobials in childhood urinary tract infection. J Korean Soc Pediatr Nephrol 2006; 10:18-26   과학기술학회마을   ScienceOn
13 Yuksel S, Ozturk B, Kavaz A, Ozcakar ZB, Acar B, Guriz H, et al. Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in turkish children with urinary tract infections. Int J Antimicrob Agents 2006;28:413-6   DOI   ScienceOn
14 Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr 1993;123:17-23   DOI   ScienceOn
15 Kang YD, Kim NS, Oh SH. Causative organisms of urinary tract infection in children, and their antibiotic susceptibility. Korean J Pediatr 2004;47:1065-71
16 Song YH, Kim DH, Park JY, Choi CH, Cho EY, Kim SM, et al. Escherichia coli susceptibility to antimicrobials in children with urinary tract infection. J Korean Soc Pediatr Nephrol 2006;10:192-200   과학기술학회마을   ScienceOn
17 Karaca Y, Coplu N, Gozalan A, Oncul O, Citil BE, Esen B. Co-trimoxazole and quinolone resistance in Escherichia coli isolated from urinary tract infections over the last 10 years. Int J Antimicrob Agents 2005;26:75-7   DOI   ScienceOn
18 Haller M, Brandis M, Berner R. Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy. Pediatr Nephrol 2004;19:982-6   DOI   ScienceOn
19 Ladhani S, Gransden W. Increasing antibiotic resistance among urinary tract isolates. Arch Dis Child 2003;88:444-5   DOI   ScienceOn
20 Kwon YD, Kim MJ, Kim HU, Oh SH, Song JY, Ko JT, et al. Antibiotic sensitivity pattern of pathogens from children with UTI. J Korean Soc Pediatr Nephrol 2006;10:182-91   과학기술학회마을   ScienceOn
21 Rushton HG. Urinary tract infections in children. epidemiology, evaluation, and management. Pediatr Clin North Am 1997;44: 1133-69   DOI   PUBMED   ScienceOn
22 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 16th informational supplement. Document M100-S16. Wayne, PA; CLSI, 2006
23 Bauer R, Kogan BA. New developments in the diagnosis and management of pediatric UTIs. Urol Clin North Am 2008;35: 47-58   DOI   ScienceOn
24 Lee YK, Lee HC, Chun JM, Yoon SY, Lee WG, Shin SM. Antibiotic sensitivity to the major causative organisms of acute urinary tract infection in children. Korean J Pediatr 2005;48:760-5
25 Baraff LJ. Management of fever without source in infants and children. Ann Emerg Med 2000;36:602-14   DOI   PUBMED   ScienceOn
26 Erb A, Sturmer T, Marre R, Brenner H. Prevalence of antibiotic resistance in Escherichia coli: Overview of geographical, temporal, and methodological variations. Eur J Clin Microbiol Infect Dis 2007;26:83-90   DOI   ScienceOn
27 Prelog M, Schiefecker D, Fille M, Wurzner R, Brunner A, Zimmerhackl LB. Febrile urinary tract infection in children: Ampicillin and trimethoprim insufficient as empirical mono- therapy. Pediatr Nephrol 2008;23:597-602   DOI   ScienceOn