title: Antibiotic susceptibility patterns of isolates from children with urinary tract infection in Isfahan, Iran: Impact on empirical treatment.
abstract: The aim of this study was to identify the antibiotic susceptibility of bacteria causing urinary tract infections (UTIs) in children in Isfahan, Iran.
  
  
  
  Retrospective and prospective analyses were conducted on isolates from children with UTIs in a referral teaching hospital of Isfahan during 2013-2015. Findings were compared between first episode versus recurrent, nosocomial versus community-acquired, previous antibiotic use versus no previous antibiotic use, and febrile versus afebrile cases.
  
  
  
  Among 364 patients, 68.1% had no previous UTI, 19.7% has received antibiotics prior to infection and 96.2% were infected outside the hospital. Escherichia coli was the leading cause of UTI (68.1%), followed by Enterobacter (9.3%), Klebsiella (8.8%) and other bacteria (13.7%). Most isolates were relatively highly susceptible to imipenem (79.2%), ciprofloxacin (78.0%) and nitrofurantoin (70.8%), whereas sensitivity to cefotaxime (53%), cefalexin (39.8%) and trimethoprim/sulfamethoxazole (SXT) (26.1%) was low. Resistance to imipenem, cefotaxime and cefalexin was more prevalent in recurrent cases as well as in patients consuming antibiotics prior to UTI. Resistance of nosocomial cases to nitrofurantoin and cefotaxime was higher. In addition, afebrile patients had isolates that were more resistant to imipenem, ciprofloxacin and cefotaxime. Significant cross-resistance was found between most of the studied antibiotics.
  
  
  
  Urinary pathogens showed low susceptibility to cefalexin, SXT and cefotaxime and high susceptibility to imipenem, ciprofloxacin and nitrofurantoin. Therefore, use of imipenem and ciprofloxacin should be considered in hospitalised children with severe or complicated disease. In addition, nitrofurantoin is a good option in afebrile cases and for UTI chemoprophylaxis in this area.
authors.affiliation: Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Karimian
authors.affiliation: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Kermani
authors.affiliation: Department of Biology, Faculty of Science, Shahid Bahonar University of Sciences, Kerman, Iran.
authors.forename: Moj
authors.initials: M
authors.lastname: Khaleghi
authors.affiliation: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.affiliation: Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Ataei
authors.affiliation: Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address: n_mostafavy@med.mui.ac.ir.
authors.forename: Nasser
authors.initials: N
authors.lastname: Mostafavi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007492:Iran; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial susceptibility; Children; Iran; Pathogens; Urinary tract infection