title: Gram-negative urinary tract infections and increasing isolation of ESBL-producing or ceftazidime-resistant strains in children: results from a single-centre survey.
abstract: Urinary tract infections (UTIs) are an important cause of morbidity in paediatrics, especially related to urinary tract malformation and neurogenic bladder dysfunction. The infection control team of Istituto Giannina Gaslini, Genova, Italy, performs a prospective survey on the epidemiology of UTI in children admitted in the hospital, and data are expressed as episodes/1000 days of hospital admission. From 2007 to 2011 there was an increase in the rate of Gram-negative UTIs, especially in the Nephrology Unit (from 11.63 to 27.48, r-coefficient 0.95, P minor 0.05), associated with an increase in infections due to ESBL-producing strains (from 0.54 to 2.55, r-coefficient 0.89, P 0.05). This study indicates that there is an increase in the rate of Gram-negative UTIs, also due to resistant strains. The cause may be multifactorial, but it is noteworthy that it has been mainly observed in a ward where low-dose, long-term administration of antibacterial prophylaxis in children with urinary malformations or neurogenic bladder dysfunction is routine. This phenomenon gives cause for concern and should be monitored carefully to avoid the risk of selecting resistant bacteria that have no therapeutic options.
authors.affiliation: Stem Cell Transplant Unit, Department of Hematology and Oncology, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Giardino
authors.forename: Roberto
authors.initials: R
authors.lastname: Bandettini
authors.forename: Maddalena
authors.initials: M
authors.lastname: Perotti
authors.forename: Giorgio
authors.initials: G
authors.lastname: Piaggio
authors.forename: Ludovica
authors.initials: L
authors.lastname: Degl'Innocenti
authors.forename: Rosanna
authors.initials: R
authors.lastname: Sacco
authors.forename: Antonella
authors.initials: A
authors.lastname: Ciucci
authors.forename: Ilaria
authors.initials: I
authors.lastname: Caviglia
authors.forename: Paola
authors.initials: P
authors.lastname: Barabino
authors.forename: Francesca
authors.initials: F
authors.lastname: Ginocchio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Losurdo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002442:Ceftazidime / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000201:enzymology / Q000378:metabolism; D004927:Escherichia coli Infections / Q000188:drug therapy; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D006306:Health Surveys; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime; D001618:beta-Lactamases