title: Urinary tract infections in hospital pediatrics: many previous antibiotherapy and antibiotics resistance, including fluoroquinolones.
abstract: OBJECTIVE
  We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population.
  
  
  METHODS
  We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record.
  
  
  RESULTS
  One hundred and ten patients (73 girls), 11 days to 12 years of age, were included in 10 months. Ninety-six percent presented with pyelonephritis, associated to uropathy for 25%. Escherichia coli was predominant (78%), followed by Proteus spp. and Enterococcus spp. The antibiotic resistance rate of E. coli was high and close to that reported for adults with complicated UTIs: amoxicillin 60%, amoxicillin-clavulanate 35%, cefotaxim 5%, trimethoprim-sulfametoxazole 26%, nalidixic acid 9%, ciprofloxacin 7%, gentamycin 1%, nitrofurantoin and fosfomycin 0%. The antibiotic exposure in the previous 12 months involved 62 children (56%) most frequently with β-lactams (89%) for a respiratory tract infection (56%). A clear relationship between exposure and resistance was observed for amoxicillin (71% vs. 46%), first generation (65% vs. 46%) and third generation (9% vs. 3%) cephalosporins, or trimethoprim-sulfamethoxazole (36% vs. 15%). However, antibiotic exposure could not account alone for the results, as suggested by the 7% of ciprofloxacin resistance, observed without any identified previous treatment.
  
  
  CONCLUSIONS
  Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved (previous antibiotic therapies and fecal-oral or mother-to-child transmission).
authors: Service de pédiatrie générale, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Service de pédiatrie générale, CHG d'Évreux, rue L.-Schwartzenberg, Évreux, France. Electronic address: agarraffo@hotmail.com.
authors: A
authors: A
authors: Garraffo
authors: Service de pédiatrie générale, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
authors: C
authors: C
authors: Marguet
authors: Service de pédiatrie générale, CHG d'Évreux, rue L.-Schwartzenberg, Évreux, France.
authors: A
authors: A
authors: Checoury
authors: Service de bactériologie, CHU de Rouen, 1, rue de Germont, Rouen, France.
authors: S
authors: S
authors: Boyer
authors: Service de bactériologie, CHG d'Évreux, rue L.-Schwartzenberg, Évreux, France.
authors: A
authors: A
authors: Gardrat
authors: Service de biostatistiques, CHU de Rouen, 1, rue de Germont, Rouen, France.
authors: E
authors: E
authors: Houivet
authors: Service de maladies infectieuses et tropicales, CHU de Rouen, 1, rue de Germont, Rouen, France.
authors: F
authors: F
authors: Caron
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Bacterial resistance; Infection urinaire; Pediatric; Pédiatrie; Résistances bactériennes; Urinary tract infection