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Rising resistance of urinary tract pathogens in children: a cause for concern

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Abstract

Background

Urinary tract infection (UTI) is one of the common infections in childhood. Prompt diagnosis and treatment reduces the risk of complications. The choice of antibiotic to treat UTI varies from region to region. Rational use and appropriately chosen antibiotic reduces the emergence of resistant uropathogens.

Objective

We investigated the resistance pattern of uropathogens for commonly used antibiotics to treat UTI locally.

Methods

Data was collected between 2009 and 2019 on all infants and children under 16 years of age with culture proven UTI. Results were compared with previously published figures between 2002 and 2008.

Results

A total of 1002 samples were analysed (91/year). Male to female ratio was 1:4.6. About 94% of the samples grew E. coli. As before, high resistance rates were recorded to Amoxicillin and Trimethoprim (Z = −0.325: P = 0.7452; not significant). Overall, average resistance has decreased for Nitrofurantoin from 10% between 2002 and 2008 to 5.84% between 2009 and 2019 (Z = 3.002: P = 0.0027). On the other hand, Cefalexin resistance has increased from 7.4 to 14.56% between the two study periods (Z = −4.2: P = < 0.0002).

Conclusion

Despite rising resistance rates, we recommend that Cefalexin should cautiously remain the antibiotic of choice for empirically treating uncomplicated urinary tract infections in secondary care pending urine culture. Nitrofurantoin should be reserved for treating non-coliform/atypical UTIs or multi-drug resistant UTIs. There is an ongoing need for clinicians in all geographic regions to continue to monitor antibiotic resistance rates every few years.

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Acknowledgements

Authors would like to thank Dr DN Sobithadevi and Dr Yasmin Jolly for their help in data collection.

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Authors and Affiliations

  1. Department of Paediatrics, Queen’s Hospital, Belvedere Road, Burton upon Trent, UK

    Mansoor Ahmed, Wan Norafifah Wan Long & Sidra Javed

  2. Clinical Chemistry, University Hospitals of Derby and Burton NHS Foundation Trust, Queen’s Hospital, Burton upon Trent, Staffordshire, DE13 0RB, UK

    Timothy Reynolds

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  1. Mansoor Ahmed
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  2. Wan Norafifah Wan Long
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  3. Sidra Javed
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  4. Timothy Reynolds
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Contributions

All authors have participated in data collection, data analysis, writing the manuscript, and approval of the submitted version of the manuscript.

Corresponding author

Correspondence to Mansoor Ahmed.

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Ahmed, M., Long, W.N.W., Javed, S. et al. Rising resistance of urinary tract pathogens in children: a cause for concern. Ir J Med Sci 191, 279–282 (2022). https://doi.org/10.1007/s11845-021-02531-4

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  • DOI: https://doi.org/10.1007/s11845-021-02531-4

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