title: Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections.
abstract: The changing pattern of antimicrobial resistance in the causative microorganisms of urinary tract infection (UTI) in childhood is a growing problem. The aims of this study were to assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of UTI. A prospective cross-sectional analysis of bacteria isolated from children with UTI was performed between January 2003 and January 2004. Resistance to antibiotics was analysed in three age groups: Group I, < or =12 months; Group II, 13-60 months; and Group III, >60 months. A total of 165 urinary pathogens were isolated from 131 patients. Mean patient age was 63.7+/-49.8 months. The most common causative agent was Escherichia coli (87% of cases) followed by Klebsiella pneumoniae (10%). Resistance to ampicillin (74.2%) and co-trimoxazole (61.3%) was significant in all isolates. Nitrofurantoin was the most active agent against E. coli (2.2% resistant isolates), followed by amikacin (4.9%), ceftriaxone (7.5%) and ciprofloxacin (12%). None of the isolates from Group I patients were resistant to ciprofloxacin and a low resistance rate (7.1%) was noted for amikacin. In Group II patients, none of the isolates were resistant to amikacin, and ceftriaxone was the second most suitable antibiotic (resistance rate 2.2%). In Group III patients, the lowest resistance rate was against nitrofurantoin (2.7%). In conclusion, we observed that the use of ampicillin and co-trimoxazole as a single agent for empirical treatment of a suspected UTI would not cover the majority of urinary pathogens in our region. Whilst amikacin, with a negligible resistance rate, was suitable in all age groups, gentamicin might still be useful as an empirical treatment of UTI in children aged >1 year. Nitrofurantoin could be included as a reasonable alternative in the empirical treatment of lower UTI in older children.
authors.affiliation: Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey. selcukyuksel.nephrology@gmail.com
authors.forename: Selçuk
authors.initials: S
authors.lastname: Yüksel
authors.forename: Burcu
authors.initials: B
authors.lastname: Oztürk
authors.forename: Asli
authors.initials: A
authors.lastname: Kavaz
authors.forename: Z Birsin
authors.initials: ZB
authors.lastname: Ozçakar
authors.forename: Banu
authors.initials: B
authors.lastname: Acar
authors.forename: Haluk
authors.initials: H
authors.lastname: Güriz
authors.forename: Derya
authors.initials: D
authors.lastname: Aysev
authors.forename: Mesiha
authors.initials: M
authors.lastname: Ekim
authors.forename: Fatoş
authors.initials: F
authors.lastname: Yalçinkaya
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000583:Amikacin / Q000494:pharmacology / Q000627:therapeutic use; D000667:Ampicillin / Q000494:pharmacology / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002443:Ceftriaxone / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D009582:Nitrofurantoin / Q000494:pharmacology / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use; D014421:Turkey / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D005839:Gentamicins; D002939:Ciprofloxacin; D002443:Ceftriaxone; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D009582:Nitrofurantoin