title: Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group.
abstract: Knowledge of the distribution spectrum of causative organisms and their resistance patterns has become a core requirement for the rational and effective management of urinary tract infections. In the context of a prospective trial on the use of antibiotic prophylaxis in infants with underling kidney malformations, we conducted an online survey among paediatric nephrologists on positive urine cultures (July 2010-June 2012) from both hospitalized and non-hospitalized infants under 24 months of age. We collected 4745 urine cultures (UCs) at 18 units in 10 European countries. Escherichia coli was the most frequent bacterium isolated from UCs; however, in 10/16 hospitals and in 6/15 community settings, E. coli was isolated in less than 50% of the total positive UCs. Other bacterial strains were Klebsiella, Enterococcus, Proteus and Pseudomonas not only from hospital settings. E. coli showed a high resistance to amoxicillin and trimethoprim and variable to cephalosporin. Nitrofurantoin had a good rate of efficacy, with 11/16 hospitals and 11/14 community settings reporting a resistance lower than 5%.
  
  
  CONCLUSIONS
  E. coli is the most common organism causing UTIs in infants; however, other bacterial strains are frequently isolated. As a result, antibiotic prophylaxis should be more elastic and adaptable over time in order to guarantee maximum efficacy.
authors.affiliation: Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi Bologna, Via Massarenti 11, 40138, Bologna, Italy, ire.alberici@gmail.com.
authors.forename: Irene
authors.initials: I
authors.lastname: Alberici
authors.forename: Aysun Karabay
authors.initials: AK
authors.lastname: Bayazit
authors.forename: Dorota
authors.initials: D
authors.lastname: Drozdz
authors.forename: Sevinç
authors.initials: S
authors.lastname: Emre
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.forename: Jérôme
authors.initials: J
authors.lastname: Harambat
authors.forename: Augustina
authors.initials: A
authors.lastname: Jankauskiene
authors.forename: Mieczyslaw
authors.initials: M
authors.lastname: Litwin
authors.forename: Sevgi
authors.initials: S
authors.lastname: Mir
authors.forename: William
authors.initials: W
authors.lastname: Morello
authors.forename: Amira
authors.initials: A
authors.lastname: Peco-Antic
authors.forename: Peter
authors.initials: P
authors.lastname: Sallay
authors.forename: Lale
authors.initials: L
authors.lastname: Sever
authors.forename: Giacomo D
authors.initials: GD
authors.lastname: Simonetti
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Szczesniak
authors.forename: Ana
authors.initials: A
authors.lastname: Teixeira
authors.forename: Enrico
authors.initials: E
authors.lastname: Vidal
authors.forename: Elke
authors.initials: E
authors.lastname: Wuehl
authors.forename: Otto
authors.initials: O
authors.lastname: Mehls
authors.forename: Lutz T
authors.initials: LT
authors.lastname: Weber
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
mesh_terms: D000658:Amoxicillin / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005060:Europe; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities; D007709:Klebsiella / Q000302:isolation & purification; D009582:Nitrofurantoin / Q000494:pharmacology; D011446:Prospective Studies; D011511:Proteus / Q000302:isolation & purification; D011549:Pseudomonas / Q000302:isolation & purification; D011795:Surveys and Questionnaires; D014295:Trimethoprim / Q000494:pharmacology; D014552:Urinary Tract Infections / Q000382:microbiology*; D014556:Urine / Q000382:microbiology
chemical_list: D002511:Cephalosporins; C012235:cephalosporin 112384; D000658:Amoxicillin; D009582:Nitrofurantoin; D014295:Trimethoprim