title: Resistance to oral antibiotics in 4569 Gram-negative rods isolated from urinary tract infection in children.
abstract: To investigate antibiotic resistance among pathogens isolated from urines in a tertiary care children's hospital in Italy. Retrospective analysis of prospectively collected data on antibiotic susceptibility of Gram-negatives isolated from urines at the Istituto Giannina Gaslini, Genoa - Italy from 2007 to 2014. Antibiotic susceptibility was evaluated. By means of CLSI criteria from 2007 to 2010, while from 2011 EUCAST criteria were adopted. Data on susceptibility to amoxicillin-clavulanate, co-trimoxazole, cefuroxime, nitrofurantoin, fosfomycin and ciprofloxacin were evaluated for Escherichia coli, while for other Enterobacteriaceae data were collected for amoxicillin-clavulanate, co-trimoxazole and ciprofloxacin and for ciprofloxacin against Pseudomonas aeruginosa. Univariate and multivariable analyses were performed for risk factors associated with resistance. A total of 4596 Gram-negative strains were observed in 3364 patients. A significant increase in the proportion of resistant strains was observed for E.coli against amoxicillin-clavulanate, cefuroxime and ciprofloxacin and for others Enterobacteriaceae against co-trimoxazole and ciprofloxacin. Resistance to nitrofurantoin and fosfomycin was very infrequent in E.coli. Logistic regression analysis showed that repeated episode of urinary tract infections was a risk factor for E.coli resistance to amoxicillin-clavulanate, co-trimoxazole and cefuroxime, while admission in one of the Units usually managing children with urinary tract malformations was significantly associated to resistance to amoxicillin-clavulanate and cefuroxime.
  
  
  CONCLUSIONS
  In conclusion the present study shows an increase in antibiotic resistance in pediatric bacteria isolated from urines in children, especially in presence of repeated episodes and/or urinary tract malformations. This resistance is worrisome for beta-lactams and cotrimoxazole, and start to increase also for fluoroquinolones while nitrofurantoin and fosfomycin still could represent useful drugs for oral treatment of these infections.
  
  
  BACKGROUND
  • Infections are frequent in patients with urinary tract malformations • Antibiotic prophylaxis can select for resistant pathogens What is New: • The increase in the resistance to β-lactams, co-trimoxazole or fluoroquinolones in pathogens causing urinary tract infections cause a reduction of drugs with oral formulations available for therapy • Old drugs like nitrofurantoin and fosfomycin can represent attractive compounds for oral treatment of urinary tract infections in children presence of resistance to other drug classes.
authors: Infectious Diseases Unit, Department of Health Sciences, University of Genoa IRCCS San Martino-IST, Genoa, Italy.
authors: Anna
authors: A
authors: Calzi
authors: Infectious Diseases Unit, Department of Health Sciences, University of Genoa IRCCS San Martino-IST, Genoa, Italy.
authors: Sara
authors: S
authors: Grignolo
authors: Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors: Ilaria
authors: I
authors: Caviglia
authors: Epidemiology and Biostatistics Service, Istituto Giannina Gaslini, Genoa, Italy.
authors: Maria Grazia
authors: MG
authors: Calevo
authors: Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors: Giuseppe
authors: G
authors: Losurdo
authors: Nephrology and Dialysis Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors: Giorgio
authors: G
authors: Piaggio
authors: Laboratory of Analysis, Istituto Giannina Gaslini, Genoa, Italy.
authors: Roberto
authors: R
authors: Bandettini
authors: Infectious Diseases Unit, Istituto Giannina Gaslini, Genoa, Italy. eliocastagnola@gaslini.org.
authors: Elio
authors: E
authors: Castagnola
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012044:Regression Analysis; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology* / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents
keywords: Children; Gram-negative rods; Oral antibiotics; Urinary tract infection