Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy
Susanna Esposito,
Giuseppe Maglietta,
Margherita Di Costanzo,
Martina Ceccoli,
Gianluca Vergine,
Claudio La Scola,
Cristina Malaventura,
Alice Falcioni,
Alessandra Iacono,
Antonella Crisafi,
Lorenzo Iughetti,
Maria Luisa Conte,
Luca Pierantoni,
Claudia Gatti,
Caterina Caminiti,
Giacomo Biasucci,
on behalf of the UTI-Ped-ER Study Group
Affiliations
Susanna Esposito
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
Giuseppe Maglietta
Research and Innovation Unit, University Hospital, 43126 Parma, Italy
Margherita Di Costanzo
Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
Martina Ceccoli
Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
Gianluca Vergine
Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
Claudio La Scola
Paediatric Clinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
Cristina Malaventura
Paediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
Alice Falcioni
Paediatric Unit, Forlì Hospital, AUSL Romagna, 47121 Forlì, Italy
Alessandra Iacono
Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
Antonella Crisafi
Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
Lorenzo Iughetti
Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
Maria Luisa Conte
Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
Luca Pierantoni
Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
Claudia Gatti
Paediatric Surgery, University Hospital, 43126 Parma, Italy
Caterina Caminiti
Research and Innovation Unit, University Hospital, 43126 Parma, Italy
Giacomo Biasucci
Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy
The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between 1 January 2012, and 30 June 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.
