title: Increasing antibiotic resistance among uropathogens isolated during years 2006-2009: impact on the empirical management.
abstract: Urinary tract infections (UTI) are one of the most common infections with an increasing resistance to antimicrobial agents.
  
  
  OBJECTIVE
  Empirical initial antibiotic treatment of UTI must rely on susceptible data from local studies.
  
  
  METHODS
  Retrospective analysis of isolated bacteria from children with UTIs was performed at the university hospital during years 2006-2009. The findings were compared with data collected in a similar study carried out in 2002-2003.
  
  
  RESULTS
  A total of 1439 uropathogens were isolated. Escherichia coli (E.coli) was the leading cause, followed by Enterobacter, and other gram negative bacilli. It was observed resistance of E.coli to ceftriaxone, cefexime, amikacin, gentamycin, and nalidixic acid; Enterobacter to cefexime; and the resistance of gram negative bacilli to gentamicin and cefexime increased significantly. The highest effective antibiotic was Imipenem, ciprofloxacin, and amikacin with 96.7%, 95% and 91% sensitivity rates, respectively, followed by ceftriaxone 77.2%, gentamicin 77%, nitrofurantoin 76.4%, nalidixic acid 74.3% and cefexime with 70%.
  
  
  CONCLUSIONS
  The use of nitrofurantoin or nalidixic acid as initial empirical antibacterial therapy for cystitis seems appropriate. For cases of simple febrile UTI, the use of initial parenteral therapies with amikacin or ceftriaxone followed by an oral third generation cephalosporin also seemed appropriated, and in cases of severely ill patients or complicated UTI, imipenem as monotherapy or, a combination of Ceftriaxone with an aminoglycoside, are recommended.
authors.affiliation: Department of Pediatric Nephrology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Mohammad-Jafari
authors.forename: Mohammed Jafar
authors.initials: MJ
authors.lastname: Saffar
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Nemate
authors.forename: Hana
authors.initials: H
authors.lastname: Saffar
authors.forename: Ali-Reza
authors.initials: AR
authors.lastname: Khalilian
mesh_terms: D000583:Amikacin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000188:drug therapy*; D002443:Ceftriaxone / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D002939:Ciprofloxacin / Q000494:pharmacology; D003556:Cystitis / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004754:Enterobacter / Q000187:drug effects; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008826:Microbial Sensitivity Tests; D009268:Nalidixic Acid / Q000494:pharmacology; D009582:Nitrofurantoin / Q000494:pharmacology; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D009268:Nalidixic Acid; D002939:Ciprofloxacin; D002443:Ceftriaxone; D000583:Amikacin; D009582:Nitrofurantoin