626 ANTIBIOTIC RESISTANCE PATTERNS IN OUTPATIENT PEDIATRIC URINARY TRACT INFECTIONS

Abstract

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012626 ANTIBIOTIC RESISTANCE PATTERNS IN OUTPATIENT PEDIATRIC URINARY TRACT INFECTIONS Rachel Edlin, Daniel Shapiro, Adam Hersh, and Hillary Copp Rachel EdlinRachel Edlin San Francisco, CA More articles by this author , Daniel ShapiroDaniel Shapiro San Francisco, CA More articles by this author , Adam HershAdam Hersh Salt Lake City, UT More articles by this author , and Hillary CoppHillary Copp San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.704AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies on antibiotic resistance patterns among pediatric uropathogens in the US indicate that narrow-spectrum agents are frequently appropriate options for treatment of urinary tract infections (UTI) among children, including nitrofurantoin, trimethoprim/sulfamethoxazole (TMP/SMX), and cefazolin. Yet, recent data indicate that prescription of certain broad-spectrum agents for UTIs such as third-generation cephalosporins is increasing. Multiple factors may contribute to this trend including physician preferences for broad-spectrum agents and/or recent changes in resistance patterns. We sought to describe current patterns of antibiotic resistance in pediatric UTI. METHODS We examined bacterial resistance patterns in outpatient urinary isolates from children <18 years in 2009 using The Surveillance Network, a database that consists of antimicrobial test results and patient demographic data from 195 US hospitals. We determined the prevalence and antibiotic susceptibility patterns for the six most common uropathogens: Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa, and Enterococcus. Chi-square analysis was used to compare differences in uropathogen prevalence between males and females. RESULTS There were a total of 25,436 urinary isolates from 22,500 patients; the majority of isolates were from females (86%). Escherichia coli was the most common uropathogen, but the prevalence of Escherichia coli was significantly higher among females (83%) than males (50%) (p<0.001). Other common species among males were Enterococcus, (17%), Pseudomonas aeruginosa (11%) and Klebsiella (10%); however, in females these uropathogens each accounted for <5% of the urinary isolates (p<0.001). Resistance among Escherichia coli was highest for TMP/SMX (24%) and lowest for nitrofurantoin (<1%) and cefazolin (4%). Few Enterococcus and Pseudomonas isolates were resistant to nitrofurantoin (<1%). Klebsiella had low levels of resistance to cefazolin (7%) and higher levels of resistance to TMP/SMX (15%) and nitrofurantoin (17%). CONCLUSIONS Baseline uropathogen resistance rates make TMP/SMX a poor prescribing option in the empiric treatment of UTI. First-generation cephalosporins are appropriate narrow-spectrum alternatives given their low resistance rates. When fever is absent nitrofurantoin is also a suitable choice. Further studies investigating empiric prescribing patterns are necessary given that most UTIs are susceptible to narrow-spectrum agents. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e255 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Edlin San Francisco, CA More articles by this author Daniel Shapiro San Francisco, CA More articles by this author Adam Hersh Salt Lake City, UT More articles by this author Hillary Copp San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...