Antibiotic resistance in children with complicated urinary tract infection.
OBJECTIVE
To determine the resistance of antibiotics for complicated urinary tract infection (UTI), including urinary tract anomaly (UTA), for empirical antibiotic therapy of complicated UTI.


METHODS
Four hundred and twenty urine isolates were obtained from 113 patients with recurrent UTI, who used prophylactic antibiotics between February 1999 and November 2004 in the Eskisehir Osmangazi University, Eskisehir, Turkey.


RESULTS
Reflux was found to be the most important predisposing factor for recurrent UTI (31.9%). Renal scar was detected more in patients with UTA than without UTA (59.2% versus 12.4%, p<0.05). Gram-negative organisms were dominant in patients with and without UTA (91.5% and 79.2%). Enterococci and Candida spp. were more prevalent in children with UTA than without UTA (p<0.001). Isolates were significantly more resistant to ampicillin, trimethoprim-sulfamethoxazole, amikacin, co-amoxiclav, ticarcillin-clavulanate, and piperacillin-tazobactam in patients with UTA than without UTA. We found low resistance to ciprofloxacin and nitrofurantoin in UTI with and without UTA. Enterococci spp. was highly resistance to ampicillin and amikacin in patients with UTA.


CONCLUSIONS
Aztreonam, meropenem, and ciprofloxacin seemed to be the best choice for treatment of UTI with UTA due to Escherichia coli and Klebsiella spp. Nitrofurantoin and nalidixic acid may be first choice antibiotics for prophylaxis in UTI with and without UTA. The UTI with UTA caused by Enterococci spp. might not benefit from a combination of amikacin and ampicillin, it could be treated with glycopeptides.
Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, TR-26480, Eskisehir, Turkey. bilalyn@yahoo.com
Bilal
B
Yildiz
Nurdan
N
Kural
Gul
G
Durmaz
Coskun
C
Yarar
Ilknur
I
Ak
Nevbahar
N
Akcar
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology