Antimicrobial resistance of childhood uropathogens

Abstract

As one of the common childhood infections, urinary tract infections (UTIs) take up an important part of a pediatrician’s daily routine practice. Not only can UTIs lead to life-threatining complications in infants, but also to renal scarring and related complications in all age groups. In order to avoid morbidity, it is suggested that treatment should be started as soon as a UTI is recognized, but because urine cultures (the gold-standard for the diagnosis of UTI) take 24–48 h to process, initial treatment is started empirically. At this point, knowledge of the pathogens causing the UTI and local antibiotic sensitivity patterns are needed to ensure appropriate treatment. With this purpose, studies were conducted all over the world and high levels of resistance to ampicillin, cephalexin and trimethoprim-sulphametoxazole were commonly reported. The prevalence of antibiotic resistance of uropathogens in complicated and recurrent UTIs was found to be even higher than that in first, uncomplicated UTIs. Multidrug resistance in pediatric UTIs has been determined to be 3.1–7.1% and the most commonly reported coresistance is to ampicillin and trimethoprim-sulphametoxazole. Cefuroxime, cefixime and cefdinir in addition to co-amoxilav are suggested as first-line oral antibiotics, whereas aminoglycosides are suggested for use in the parenteral treatment of UTIs. With low resistance rates, nitrofurantoin is recommended for the treatment of cystitis and prophylaxis.