Pediatric Nephrology

, 23:597 | Cite as

Febrile urinary tract infection in children: ampicillin and trimethoprim insufficient as empirical mono-therapy

  • Martina Prelog
  • Daniela Schiefecker
  • Manfred Fille
  • Reinhard Wurzner
  • Andrea Brunner
  • Lothar Bernd Zimmerhackl
Original Article

Abstract

The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in defined groups of children (total number 694) with urinary tract infection (UTI) regarding age, first UTI (FUTI) or recurrent UTI (RUTI), renal abnormalities or vesico-ureteric reflux (VUR) in order to optimize empirical antibiotic therapy and prophylaxis. In patients aged between 1 month and 24 months with a first febrile UTI (FUTI; n = 205) the leading pathogen was Escherichia coli (E. coli) (83.4%). In comparison with patients with FUTI, those with RUTI (n = 24) had more Enterococcus and Enterobacter infections and higher resistance rates of E. coli against trimethoprim (TMP), trimethoprim/sulfamethoxazole (SXT) or ampicillin (AMP). Boys with ultrasound-detected renal abnormalities (n = 71) showed 14.2% Pseudomonas and 59.1% E. coli infections versus girls (n = 48) (2.1% Pseudomonas and 93.7% E. coli). Of 390 patients who underwent voiding cysto-urethrography, 31.5% had VUR. Of them, 45.5% received antimicrobial prophylaxis with SXT (n = 30) or cefazolin (n = 26). There was no difference between girls (n = 242) and boys (n = 148) regarding the frequency of VUR and pathogens. There were more TMP- and SXT-resistant E. coli cultures from patients with VUR (37.8%) than from those without VUR (25.8%). Treatment with TMP, SXT and AMP alone appeared to be insufficient in many cases because of high resistance rates of E. coli and other uropathogens.

Keywords

Urinary tract infection Resistance Uropathogen Children Vesico-ureteric reflux Kidney abnormalities 

Notes

Acknowledgment

We thank Hanno Ulmer, Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria, for statistical assistance.

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Copyright information

© IPNA 2007

Authors and Affiliations

  • Martina Prelog
    • 1
  • Daniela Schiefecker
    • 1
  • Manfred Fille
    • 2
  • Reinhard Wurzner
    • 2
  • Andrea Brunner
    • 3
  • Lothar Bernd Zimmerhackl
    • 1
  1. 1.Department of PediatricsInnsbruck Medical UniversityInnsbruckAustria
  2. 2.Department of Hygiene, Microbiology and Social MedicineMedical University of InnsbruckInnsbruckAustria
  3. 3.Department of PathologyMedical University of InnsbruckInnsbruckAustria

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