title: Cephalosporin resistant urinary tract infections in young children.
abstract: OBJECTIVE
  To describe the antibiotic resistance pattern of bacteria causing urinary tract infection (UTI) in a cohort of Australian children under 6 years of age.
  
  
  METHODS
  Data were collected over a 12-month period from children under 6 years of age with a provisional diagnosis of UTI made in the Emergency Department of Sunshine Hospital, Victoria.
  
  
  RESULTS
  During the study period 100 culture-proven UTI were identified in 97 children. Three children had two episodes. Out of the 100 episodes, 39% were male, 56% were under 12 months of age at presentation and 61% were managed as outpatients. Clinical features were non-specific in the majority of cases. Hydronephrosis and vesicoureteric reflux was detected in 5.5% and 28.6%, respectively, of children with their first investigated UTI. A single bacterial isolate was cultured from 97 urines and two from three samples. Escherichia coli (n = 90) and Proteus mirabilis (n = 5) were the most common isolates. In vitro resistance to ampicillin/amoxycillin was found in 52% of isolates, to trimethoprim in 14% and to cephalothin/cephalexin in 24%. This resistance rate to first generation cephalosporins is the highest reported to date in adult or paediatric UTI in Australia.
  
  
  CONCLUSIONS
  Ampicillin/amoxycillin or cephalothin/cephalexin may not be the optimal choice of antibiotic for the empiric treatment of UTI in this and possibly other paediatric populations.
authors.affiliation: Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Australia.
authors.forename: S S
authors.initials: SS
authors.lastname: Mehr
authors.forename: C V E
authors.initials: CV
authors.lastname: Powell
authors.forename: N
authors.initials: N
authors.lastname: Curtis
mesh_terms: D018550:Cephalosporin Resistance / Q000502:physiology*; D002648:Child; D015331:Cohort Studies; D004927:Escherichia coli Infections / Q000382:microbiology; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D015995:Prevalence; D011512:Proteus Infections / Q000382:microbiology; D014463:Ultrasonography; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*