title: Etiological agents and antimicrobial susceptibility in hospitalized children with acute pyelonephritis.
abstract: BACKGROUND
  Antibiotic resistance driven by antibiotic use remains a major public health and professional concern. Our aim was to know the local prevalence of uropathogens and their antimicrobial susceptibility profile in acute pyelonephritis.
  
  
  METHODS
  A prospective study of patients admitted in a level III Pediatric Department ward with acute pyelonephritis from 1994 to 2012 was performed in Northern Portugal. Etiological agents and their antimicrobial sensitivity profile were evaluated in four timed periods (G1: 1994-97; G2: 2002; G3: 2007; G4: 2012).
  
  
  RESULTS
  We evaluated 581 patients, 66% female with median age 22 months. Escherichia coli was the leading uropathogen and its prevalence remained stable during the last 18 years. It showed an increased sensitivity to amoxicillin-clavulanate from 71% in G1 to 81.5% in G4 (p = 0.001) and a decreased resistance rate from 8.7% in G1 to 2.8% in G4 (p = 0.008). Its sensitivity to 2nd and 3rd generation cephalosporin was more than 90% (p = ns) and more than 95% to nitrofurantoin (p = ns). Resistance rate of cotrimoxazole increased from 22% to 26% (p = 0.008).
  
  
  CONCLUSIONS
  Escherichia coli remains the main uropathogen responsible for acute pyelonephritis, reason why its antimicrobial sensitivity profile will determine the empirical therapeutic choice.
  
  
  CONCLUSIONS
  Amoxicillin-clavulanate remains a good first-line choice for empirical treatment of acute pyelonephritis in our inpatient health care.
authors: Unit of Pediatric Nephrology. Hospital Pediátrico Integrado. Centro Hospitalar de São João. Porto. Portugal. Faculty of Medicine. University of Porto. Porto. Portugal.
authors: Filipa
authors: F
authors: Flor-de-Lima
authors: Tânia
authors: T
authors: Martins
authors: Ana
authors: A
authors: Teixeira
authors: Helena
authors: H
authors: Pinto
authors: Edgar
authors: E
authors: Botelho-Moniz
authors: Alberto
authors: A
authors: Caldas-Afonso
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents