title: Treatment of recurrent complicated urinary tract infections in children with vesicoureteral reflux.
abstract: BACKGROUND
  Urinary tract infections (UTIs) in children with vesicoureteral reflux (VUR) are often caused by uropathogens with a high rate of drug resistance and are associated with a high rate of recurrence with a single pathogen. In this study, we evaluated the incidence of recurrent UTI and the drug resistance pattern of Escherichia coli in children with VUR. We also evaluated whether combination therapy comprising fosomycin plus one other antimicrobial agent is effective for treatment of recurrent UTIs.
  
  
  METHODS
  We retrospectively reviewed the medical records of all children with VUR who developed at least one episode of UTI during the period January 1, 2003 to December 31, 2013 at a single medical center. The effectiveness of fosfomycin plus amikicin for Enterobacteriaceae or ceftazidime for Pseudomonas aeruginosa infections was prospectively studied in six children with recurrent relapsing UTIs.
  
  
  RESULTS
  The study population comprised 129 children (age range, from 1month to 15 years; mean ± standard deviation, 2.37 ± 2.91 years) with VUR who developed at least one UTI during the 10-year study period; 68 (52.7%) had recurrent UTIs. The presence of an underlying urinary tract anomaly was predictive of recurrence (p = 0.028). The rates of susceptibility of E. coli to cefazolin (p < 0.001) and cefotaxime (p < 0.001) were significantly lower in patients with recurrent UTIs. Combination therapy with fosfomycin plus amikacin or ceftazidime was shown to be an effective therapeutic option for recurrent UTIs due to a single uropathogen.
  
  
  CONCLUSIONS
  The rates of susceptibility of E. coli to commonly used antimicrobials were significantly lower in children who developed more than one episode of UTI. The empiric choice of cefazolin or cefotaxime was usually ineffective. Administration of fosfomycin plus amikacin or ceftazidime was an effective therapeutic and preventive strategy in children with VUR and recurrent relapsing UTI.
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Show Chwan Memorial Hospital, Changhua, Taiwan.
authors.forename: Tsung-Hua
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Hungkuang University, Taichung, Taiwan.
authors.forename: Fang-Liang
authors.initials: FL
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Lin-Shien
authors.initials: LS
authors.lastname: Fu
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chia-Man
authors.initials: CM
authors.lastname: Chou
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Chien
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chung-Ming
authors.initials: CM
authors.lastname: Huang
authors.affiliation: Microbiology Section of the Medical Laboratory, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address: pychen@vghtc.gov.tw.
authors.forename: Po-Yen
authors.initials: PY
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D012008:Recurrence; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014718:Vesico-Ureteral Reflux / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D000583:Amikacin; D002442:Ceftazidime
keywords: children; drug susceptibility; fosfomycin; urinary tract infection; vesicoureteral reflux