title: Infants under two months of age with urinary tract infections are showing increasing resistance to empirical and oral antibiotics.
abstract: OBJECTIVE
  Data on antimicrobial resistance in uropathogens in infants up to the age of three months are limited. This study characterised resistance patterns in Gram-negative uropathogens in infants up to the age of two months.
  
  
  METHODS
  Previously healthy young infants with urinary tract infections (UTIs) were studied retrospectively. Antimicrobial susceptibility was evaluated. Multidrug resistance (MDR) was defined as resistance to at least three antibiotic classes. Clinical, laboratory and outcome data were compared between infants with UTIs caused by bacteria sensitive and resistant to empirical and to oral therapy.
  
  
  RESULTS
  We evaluated 306 UTI episodes with 314 pathogens. The following resistance rates were observed: ampicillin 73.7%, cefazoline 22.1%, ampicillin/clavulanate 21.8%, cefuroxime 7.8%, gentamicin 7%; MDR 11.8%; resistant to empirical treatment 7.3% and resistant to available oral antibiotics 8.6%. Our study showed that pathogens resistant to empirical and oral therapy were more frequently isolated in non-Jewish (Arab) infants and in those of ≥30 days of age. Resistance to empirical treatment and oral antibiotics also resulted in longer mean hospital stays.
  
  
  CONCLUSIONS
  Resistance to antibiotics challenges empirical therapy and compromises oral treatment options in young infants with UTIs. Antimicrobial resistance patterns should be monitored in infants to determine appropriate empirical antibiotic therapy protocols.
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Segal
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.|Department of Medicine Shaare Zedek Medical Center, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Matan J
authors.initials: MJ
authors.lastname: Cohen
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.|Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Engelhard
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Tenenbaum
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.|Pediatric Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ari M
authors.initials: AM
authors.lastname: Simckes
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Benenson
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Polina
authors.initials: P
authors.lastname: Stepensky
authors.affiliation: Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.|Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Averbuch
mesh_terms: D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
keywords: Antimicrobial resistance; Gram-negative bacteria; Infants; Urinary tract infection