title: Febrile urinary tract infection in children: ampicillin and trimethoprim insufficient as empirical mono-therapy.
abstract: The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in defined groups of children (total number 694) with urinary tract infection (UTI) regarding age, first UTI (FUTI) or recurrent UTI (RUTI), renal abnormalities or vesico-ureteric reflux (VUR) in order to optimize empirical antibiotic therapy and prophylaxis. In patients aged between 1 month and 24 months with a first febrile UTI (FUTI; n = 205) the leading pathogen was Escherichia coli (E. coli) (83.4%). In comparison with patients with FUTI, those with RUTI (n = 24) had more Enterococcus and Enterobacter infections and higher resistance rates of E. coli against trimethoprim (TMP), trimethoprim/sulfamethoxazole (SXT) or ampicillin (AMP). Boys with ultrasound-detected renal abnormalities (n = 71) showed 14.2% Pseudomonas and 59.1% E. coli infections versus girls (n = 48) (2.1% Pseudomonas and 93.7% E. coli). Of 390 patients who underwent voiding cysto-urethrography, 31.5% had VUR. Of them, 45.5% received antimicrobial prophylaxis with SXT (n = 30) or cefazolin (n = 26). There was no difference between girls (n = 242) and boys (n = 148) regarding the frequency of VUR and pathogens. There were more TMP- and SXT-resistant E. coli cultures from patients with VUR (37.8%) than from those without VUR (25.8%). Treatment with TMP, SXT and AMP alone appeared to be insufficient in many cases because of high resistance rates of E. coli and other uropathogens.
authors.affiliation: Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria. Martina.Prelog@i-med.ac.at
authors.forename: Martina
authors.initials: M
authors.lastname: Prelog
authors.forename: Daniela
authors.initials: D
authors.lastname: Schiefecker
authors.forename: Manfred
authors.initials: M
authors.lastname: Fille
authors.forename: Reinhard
authors.initials: R
authors.lastname: Wurzner
authors.forename: Andrea
authors.initials: A
authors.lastname: Brunner
authors.forename: Lothar Bernd
authors.initials: LB
authors.lastname: Zimmerhackl
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D004926:Escherichia coli / Q000187:drug effects; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D011549:Pseudomonas / Q000187:drug effects; D012189:Retrospective Studies; D014295:Trimethoprim / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000892:Anti-Infective Agents, Urinary; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014295:Trimethoprim