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Antibiotic Resistance in Pediatric Urinary Tract Infections

  • Antimicrobial Development and Drug Resistance (A Pakyz, Section Editor)
  • Published:
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Abstract

Urinary tract infections (UTIs) are a common problem in pediatric patients. Resistance to common antibiotic agents appears to be increasing over time, although resistance rates may vary based on geographic region or country. Prior antibiotic exposure is a pertinent risk factor for acquiring resistant organisms during a first UTI and recurrent UTI. Judicious prescribing of antibiotics for common pediatric conditions is needed to prevent additional resistance from occurring. Complex pediatric patients with histories of hospitalizations, prior antibiotic exposure, and recurrent UTIs are also at high risk for acquiring UTIs due to extended spectrum beta-lactamase-producing organisms. Data regarding the impact of in vitro antibiotic susceptibility testing interpretation on UTI treatment outcomes is lacking.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27(4):302–8. doi:10.1097/INF.0b013e31815e4122.

    Article  PubMed  Google Scholar 

  2. Freedman AL, Urologic Diseases in America Project. Urologic diseases in North America Project: trends in resource utilization for urinary tract infections in children. J Urol. 2005;173(3):949–54.

    Article  PubMed  Google Scholar 

  3. Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol. 2013;190(1):222–7. doi:10.1016/j.juro.2013.01.069.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Dayan N, Dabbah H, Weissman I, Aga I, Even L, Glikman D. Urinary tract infections caused by community-acquired extended-spectrum beta-lactamase-producing and nonproducing bacteria: a comparative study. J Pediatr. 2013;163(5):1417–21. doi:10.1016/j.jpeds.2013.06.078.

    Article  PubMed  Google Scholar 

  5. Copp HL, Shapiro DJ, Hersh AL. National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998–2007. Pediatrics. 2011;127(6):1027–33. doi:10.1542/peds.2010-3465.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2014;7, CD003772. doi:10.1002/14651858.CD003772.pub4.

    Google Scholar 

  7. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011;128(3):595–610. doi:10.1542/peds.2011-1330.

    Article  Google Scholar 

  8. Clinical and Laboratory Science Institute. Performance standards for antimicrobial susceptibility testing: twenty-fifth informational supplement. 2015;Wayne, PA, USA: Clinical and Laboratory Standards Institute.

  9. European Committee on Antimicrobial Susceptibility Testing. Performance standards for antimicrobial susceptibility testing: twenty-fifth informational supplement. 2015;Version 5.0.

  10. Rose L, Coulter MM, Chan S, Hossain J, Di Pentima MC. Trends of fluoroquinolone-resistant Escherichia coli amongst urinary isolates in children: a 10 year surveillance study. J Med Microbiol. 2015;64(7):778–81. doi:10.1099/jmm.0.000072.

    Article  CAS  PubMed  Google Scholar 

  11. •Bitsori M, Maraki S, Galanakis E. Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis. Pediatr Nephrol. 2014;29(6):1053–8. doi:10.1007/s00467-013-2719-x. This study looked at antimicrobial resistance over a 12-year period in Greece and found significant increases in isolation of resistant organisms over the study period in pediatric patients. The study also found that prior antibiotic exposure was an independent risk factor for acquiring a UTI with a resistant organism.

    Article  PubMed  Google Scholar 

  12. Mohammad-Jafari H, Saffar MJ, Nemate I, Saffar H, Khalilian AR. Increasing antibiotic resistance among uropathogens isolated during years 2006–2009: impact on the empirical management. Int Braz J Urol. 2012;38(1):25–32.

    Article  PubMed  Google Scholar 

  13. ••Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ. 2016;352:i939. doi:10.1136/bmj.i939. This study was a meta-analysis of global E. coli UTI antimicrobial resistance in pediatric patients. It found significant differences between countries, with higher resistance rates in countries with over the counter antibiotics. Also, the meta-analysis found a significant association with prior antibiotic exposure up to 6 months and increased antibiotic resistance.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Boggan JC, Navar-Boggan AM, Jhaveri R. Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection. Pediatrics. 2012;130(3):e615–22. doi:10.1542/peds.2012-0563.

    Article  PubMed  Google Scholar 

  15. McGregor JC, Quach Y, Bearden DT, Smith DH, Sharp SE, Guzman-Cottrill JA. Variation in antibiotic susceptibility of uropathogens by age among ambulatory pediatric patients. J Pediatr Nurs. 2014;29(2):152–7. doi:10.1016/j.pedn.2013.09.001.

    Article  PubMed  Google Scholar 

  16. Keren R, Shaikh N, Pohl H, et al. Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics. 2015;136(1):e13–21. doi:10.1542/peds.2015-0409.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126(6):1084–91. doi:10.1542/peds.2010-0685.

    Article  PubMed  Google Scholar 

  18. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007;298(2):179–86.

    Article  CAS  PubMed  Google Scholar 

  19. Mantadakis E, Tsalkidis A, Panopoulou M, et al. Antimicrobial susceptibility of pediatric uropathogens in Thrace, Greece. Int Urol Nephrol. 2011;43(2):549–55. doi:10.1007/s11255-010-9768-x.

    Article  CAS  PubMed  Google Scholar 

  20. Jakovljevic E, Ilic K, Jelesic Z, Konstantinidis G. A one-year prospective study on the antibiotic resistance of E. coli strains isolated in urinary specimens of children hospitalized at the University Pediatric Medical Center in Novi Sad, Serbia. Infection. 2013;41(6):1111–9. doi:10.1007/s15010-013-0493-0.

    Article  CAS  PubMed  Google Scholar 

  21. Rezaee MA, Abdinia B. Etiology and antimicrobial susceptibility pattern of pathogenic bacteria in children subjected to UTI: a referral hospital-based study in northwest of Iran. Medicine (Baltimore). 2015;94(39), e1606. doi:10.1097/MD.0000000000001606.

    Article  CAS  Google Scholar 

  22. Paschke AA, Zaoutis T, Conway PH, Xie D, Keren R. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics. 2010;125(4):664–72. doi:10.1542/peds.2009-1527.

    Article  PubMed  Google Scholar 

  23. Caracciolo A, Bettinelli A, Bonato C, et al. Antimicrobial resistance among Escherichia coli that cause childhood community-acquired urinary tract infections in northern Italy. Ital J Pediatr. 2011;37:3. doi:10.1186/1824-7288-37-3.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Sakran W, Smolkin V, Odetalla A, Halevy R, Koren A. Community-acquired urinary tract infection in hospitalized children: etiology and antimicrobial resistance. A comparison between first episode and recurrent infection. Clin Pediatr (Phila). 2015;54(5):479–483. doi: 10.1177/0009922814555974.

  25. ••RIVUR Trial Investigators, Hoberman A, Greenfield SP, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370(25):2367–76. doi:10.1056/NEJMoa1401811. This was the largest and likely highest quality prospective study regarding the use of prophylactic antibiotics to prevent UTI for pediatric patients with vesicoureteral reflux. Important to this review, patients on prophylactic antibiotics had higher rates of UTIs due to a resistant organism.

    Article  Google Scholar 

  26. Ashkenazi-Hoffnung L, Melamed N, Ben-Haroush A, Livni G, Amir J, Bilavsky E. The association of intrapartum antibiotic exposure with the incidence and antibiotic resistance of infantile late-onset serious bacterial infections. Clin Pediatr (Phila). 2011;50(9):827–33. doi:10.1177/0009922811406260.

    Article  Google Scholar 

  27. Nelson CP, Hoberman A, Shaikh N, et al. Antimicrobial resistance and urinary tract infection recurrence. Pediatrics. 2016;137(4). doi: 10.1542/peds.2015-2490.

  28. •Fan NC, Chen HH, Chen CL, et al. Rise of community-onset urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli in children. J Microbiol Immunol Infect. 2014;47(5):399–405. doi:10.1016/j.jmii.2013.05.006. This was a study looking at ESBL production over a 5-year period in pediatric urinary isolates. Mild increases in resistance over time were noted, and risk factors for ESBL UTI pathogens were identified including recent hospitalizations, neurologic diseases, and recent antibiotic exposure.

    Article  PubMed  Google Scholar 

  29. Kizilca O, Siraneci R, Yilmaz A, et al. Risk factors for community-acquired urinary tract infection caused by ESBL-producing bacteria in children. Pediatr Int. 2012;54(6):858–62. doi:10.1111/j.1442-200X.2012.03709.x.

    Article  CAS  PubMed  Google Scholar 

  30. Tratselas A, Iosifidis E, Ioannidou M, et al. Outcome of urinary tract infections caused by extended spectrum beta-lactamase-producing Enterobacteriaceae in children. Pediatr Infect Dis J. 2011;30(8):707–10. doi:10.1097/INF.0b013e31820d7ec4.

    Article  PubMed  Google Scholar 

  31. Degnan LA, Milstone AM, Diener-West M, Lee CK. Extended-spectrum beta-lactamase bacteria from urine isolates in children. J Pediatr Pharmacol Ther. 2015;20(5):373–7. doi:10.5863/1551-6776-20.5.373.

    PubMed  PubMed Central  Google Scholar 

  32. Navidinia M, Peerayeh SN, Fallah F, Bakhshi B, Sajadinia RS. Phylogenetic grouping and pathotypic comparison of urine and fecal Escherichia coli isolates from children with urinary tract infection. Braz J Microbiol. 2014;45(2):509–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964–99. doi:10.1542/peds.2012-3488.

    Article  PubMed  Google Scholar 

  34. Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262–80.

    Article  PubMed  Google Scholar 

  35. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474–502. doi:10.1542/peds.2014-2742.

    Article  PubMed  Google Scholar 

  36. Chen PC, Chang LY, Lu CY, et al. Drug susceptibility and treatment response of common urinary tract infection pathogens in children. J Microbiol Immunol Infect. 2014;47(6):478–83. doi:10.1016/j.jmii.2013.07.011.

    Article  CAS  PubMed  Google Scholar 

  37. Bactrim(R) [package insert]. Philadelphia, PA; Mutual Pharmaceutical Company, INC:2013.

  38. Ancef (R) [package insert]. Research Triangle Park, NC; GlaxoSmithKline:2004.

  39. Lee B, Kang SY, Kang HM, et al. Outcome of antimicrobial therapy of pediatric urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Infect Chemother. 2013;45(4):415–21. doi:10.3947/ic.2013.45.4.415.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Han SB, Lee SC, Lee SY, Jeong DC, Kang JH. Aminoglycoside therapy for childhood urinary tract infection due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae. BMC Infect Dis. 2015;15:414-015-1153-z. doi: 10.1186/s12879-015-1153-z.

  41. Raz R, Chazan B, Kennes Y, et al. Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Clin Infect Dis. 2002;34(9):1165–9.

    Article  CAS  PubMed  Google Scholar 

  42. Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000;283(12):1583–90.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Smith Building, Room 435, 410 N 12th Street, P.O. Box 980533, Richmond, VA, 23298, USA

    Jeremy S. Stultz

  2. Department of Pathology, Virginia Commonwealth University Health System, Richmond, VA, 23298, USA

    Christopher D. Doern

  3. Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, 23298, USA

    Emily Godbout

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  1. Jeremy S. Stultz
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  2. Christopher D. Doern
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  3. Emily Godbout
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Correspondence to Jeremy S. Stultz.

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Drs. Stultz and Godbout declare that they have no conflicts of interests.

Dr. Doern reports personal fees from Allergan, outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Antimicrobial Development and Drug Resistance

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Stultz, J.S., Doern, C.D. & Godbout, E. Antibiotic Resistance in Pediatric Urinary Tract Infections. Curr Infect Dis Rep 18, 40 (2016). https://doi.org/10.1007/s11908-016-0555-4

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  • DOI: https://doi.org/10.1007/s11908-016-0555-4

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