Antibiotic treatment and antimicrobial resistance in children with urinary tract infections

K. Vazouras; K. Velali; I. Tassiou; A. Anastasiou-Katsiardani; K. Athanasopoulou; A. Barbouni; C. Jackson; L. Folgori; T. Zaoutis; R. Basmaci; Y. Hsia

Journal of Global Antimicrobial Resistance (Mar 2020)

Antibiotic treatment and antimicrobial resistance in children with urinary tract infections

K. Vazouras,
K. Velali,
I. Tassiou,
A. Anastasiou-Katsiardani,
K. Athanasopoulou,
A. Barbouni,
C. Jackson,
L. Folgori,
T. Zaoutis,
R. Basmaci,
Y. Hsia

Affiliations

K. Vazouras: The Stavros Niarchos Foundation–Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens, Athens, Greece; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London SW17 0RE, UK; Second Department of Pediatrics, Aghia Sophia Children΄s Hospital, Agia Sophia Hospital, Goudi, Athens, Greece; Corresponding author. Present address: The Stavros Niarchos Foundation–Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), 5 Chatzigianni Mexi, Athens 11528, Greece.
K. Velali: First Department of Pediatrics, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
I. Tassiou: Paediatrics Department, University Hospital of Larissa, Larissa, Greece
A. Anastasiou-Katsiardani: Paediatrics Department, Achillopouleion General Hospital of Volos, Volos, Greece
K. Athanasopoulou: Microbiology Department, Achillopouleion General Hospital of Volos, Volos, Greece
A. Barbouni: Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
C. Jackson: Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London SW17 0RE, UK
L. Folgori: Paediatric Infectious Disease Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
T. Zaoutis: The Stavros Niarchos Foundation–Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens, Athens, Greece; Division of Infectious Diseases, Children’s Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, PA, USA
R. Basmaci: Université de Paris, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, F-75018 Paris, France; Service de Pédiatrie-Urgences, Hôpital Louis-Mourier, Assistance Publique – Hôpitaux de Paris, F-92700 Colombes, France
Y. Hsia: Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London SW17 0RE, UK; School of Pharmacy, Queen’s University Belfast, Belfast, UK

Journal volume & issue: Vol. 20
pp. 4 – 10

Abstract

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Objectives: The aim of this study was to describe antibiotic prescribing patterns and antimicrobial resistance rates in hospitalised children with febrile and afebrile urinary tract infections (UTIs). Methods: Antibiotic prescriptions and antibiograms for neonates, infants and older children with UTI admitted to a general district hospital in Central Greece were evaluated. Data covering a 5-year period were collected retrospectively from the Paediatric Department’s Electronic Clinical Archive. Patients were included based on clinical and microbiological criteria. Antimicrobial susceptibility was determined by the Kirby–Bauer disk diffusion method. Results: A total of 230 patients were included in the study. Among 459 prescriptions identified, amikacin (31.2%) was the most common antibiotic prescribed in this population, followed by amoxicillin/clavulanic acid (17.4%) and ampicillin (13.5%). Children received prolonged intravenous (i.v.) treatments for febrile (mean ± S.D., 5.4 ± 1.45 days) and afebrile UTIs (mean ± S.D., 4.4 ± 1.64 days). A total of 236 pathogens were isolated. The main causative organism was Escherichia coli (79.2%) with high reported resistance rates to ampicillin (42.0%), trimethoprim/sulfamethoxazole (26.5%) and amoxicillin/clavulanic acid (12.2%); lower resistance rates were identified for third-generation cephalosporins (1.7%), nitrofurantoin (2.3%), ciprofloxacin (1.4%) and amikacin (0.9%). Klebsiella spp. isolates were highly resistant to cefaclor (27.3%). Conclusion: High prescribing rates for amikacin and penicillins (± β-lactamase inhibitors) and prolonged i.v. treatments were observed. Escherichia coli was highly resistant to ampicillin, whilst third-generation cephalosporins exhibited greater in vitro efficacy. Establishment of antimicrobial stewardship programmes and regular monitoring of antimicrobial resistance could help to minimise inappropriate prescribing for UTIs.

Published in Journal of Global Antimicrobial Resistance

ISSN: 2213-7165 (Print); 2213-7173 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Science: Microbiology
Website: https://www.journals.elsevier.com/journal-of-global-antimicrobial-resistance

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