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Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis

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Abstract

Background

The aim of this study was to identify long-term resistance trends of uropathogens and determine the effect of prophylaxis in a pediatric patient population.

Materials and methods

A total of 638 uropathogens were isolated from urine samples collected from children hospitalized for urinary tract infection during the 12-year study period (1997–2008) and analyzed.

Results

The most frequent uropathogen identified was Escherichia coli (69 %), followed by Klebsiella spp. (9.7 %), Pseudomonas aeruginosa (6.7 %), Enterococcus spp. (5.6 %), and Proteus spp. (4.4 %). High resistance rates were observed for common agents used for empiric treatment, such as amoxicillin, cotrimoxazole, and ceftriaxone. Resistance increased over time for nitrofurantoin, ceftriaxone, and piperacilin–tazobactam (chi-square for trend p < 0.0002, p < 0.0034 and p < 0.014, respectively) and decreased for cefuroxime (p < 0.016) and gentamicin (p < 0.014). The use of prophylaxis was related to an increased proportion of non-E. coli pathogens (46.9 vs. 26.9 %; odds ratio 2.4, 95 % confidence interval 1.61–3.55; p < 0.0001), as well as to increased resistance of non-E. coli pathogens, and was a major risk factor associated with resistance to amoxiclav (p < 0.005), cotrimoxazole (p < 0.0001), cefuroxime (p < 0.0001), ceftriaxone (p < 0.0001), gentamicin (p < 0.0001), and nitrofurantoin (p < 0.0001).

Conclusions

Our findings point to considerable changes in the long-term resistance patterns of uropathogens and an association of prophylaxis with resistance. Our results suggest the need for continuous surveillance, re-evaluation of empiric regimens and further assessment of the role of prophylaxis in the treatment of urinary tract infection.

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Authors and Affiliations

  1. Department of Paediatrics, University Hospital of Heraklion, Crete, Greece

    Maria Bitsori

  2. Department of Clinical Microbiology, University Hospital of Heraklion, Crete, Greece

    Sofia Maraki

  3. Department of Paediatrics, University of Crete, POB 2208, Heraklion, 71003, Greece

    Emmanouil Galanakis

Authors
  1. Maria Bitsori
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  2. Sofia Maraki
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  3. Emmanouil Galanakis
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Correspondence to Emmanouil Galanakis.

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Bitsori, M., Maraki, S. & Galanakis, E. Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis. Pediatr Nephrol 29, 1053–1058 (2014). https://doi.org/10.1007/s00467-013-2719-x

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  • DOI: https://doi.org/10.1007/s00467-013-2719-x

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