title: Antimicrobial resistance of urinary tract pathogens in children in Crete, Greece.
abstract: The aim of the present study was to identify the organisms responsible for community acquired febrile UTI in children and to investigate their susceptibility to commonly used antibiotics. A 5-y prospective analysis was performed in children hospitalized for a first episode of UTI, in Crete, Greece. A total of 262 children, 40.1% males and 59.9% females, aged 0.08 to 13 y, were enrolled in the study. Escherichia coli (E. coli) was the leading uropathogen. Antimicrobial resistance of E. coli isolates was most commonly to ampicillin (56.4%) followed by trimethoprim-sulfamethoxazole (TMP-SMX) (27.3%), cefaclor (22.5%), amoxicillin-clavulanate (15.5%), gentamicin (4.9%), cefuroxime (3.1%), nitrofurantoin (2.6%), and ceftriaxone (1.6%). Interestingly, a significant decrease in E. coli resistance to TMP-SMX was observed during the study period. Resistance to ampicillin, TMP-SMX and cefaclor was noted for 61%, 28% and 27% of the total uropathogens, respectively, making these agents inappropriate for empirical treatment of febrile UTI in our region. A larger number of pathogens may be empirically treated with amoxicillin-clavulanate. More than 90% of the uropathogens are susceptible to cefuroxime, ceftriaxone, gentamicin, and nitrofurantoin. In conclusion, several of the first-line agents for empirical treatment of childhood UTI seem to have become ineffective in the area of this study.
authors.affiliation: Department of Paediatrics, Venizelion General Hospital, Heraklion, Crete, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Anatoliotaki
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Galanakis
authors.forename: Athina
authors.initials: A
authors.lastname: Schinaki
authors.forename: Sofia
authors.initials: S
authors.lastname: Stefanaki
authors.forename: Maria
authors.initials: M
authors.lastname: Mavrokosta
authors.forename: Amalia
authors.initials: A
authors.lastname: Tsilimigaki
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*