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Indian Pediatr 2011;48:
812-813 |
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Trend of Antibiotic Resistance in Children
with First Acute Pyelonephritis |
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Peco-Antic Amira, Paripovic Dusan, Spasojevic –Dimitrijeva Brankica and
Buljugic Svetlana
Children’s Hospital of Medical Faculty of University of
Belgrade, Serbia.
Email:
[email protected]
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There have been many recent reports of increasing antimicrobial
resistance among uropathogens. In this study, we reviewed medical
records of children (<18 yr age) with first acute pyelonephritis
admitted to our Institution between January 2005 to December 2009. 411
children (189 girls) were studied and increasing trend in bacterial
resistance toward co-trimoxazole, 2nd and 3rd generation
cephalosporins and gentamicin were observed.
Key words: Antibiotic, Child, Pyelonephritis, Resistance,
Serbia.
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Prompt treatment of childhood acute pyelonephritis is likely to reduce the
risk of permanent renal scarring [1]. Increased antimicrobial resistance,
especially the resistance against broad-spectrum beta-lactams (ESBL)
uropathogens has jeopardized the antibiotic treatment of UTI in children
[2]. The aim of this study was to assess the changing trend of local
resistance patterns of urinary pathogens to commonly used anti-microbial
agents in Serbia during the last 5 years in children with acute
pyelonephritis.
Medical records from January 2005 to December 2009 of
all children aged less than 18 years of age admitted to the Nephrology or
Pediatrics Department at the University Children’s Hospital in Belgrade
for their first acute pyelonephritis were reviewed (n=411; 189
girls; median age 4 mo; range 0.1-112 mo). Two different periods, early
(from January 2005 to December 2007) and late (from January 2008 to
December 2009), were studied. The following antimicrobial agents were
tested: ampicillin (AMP), a combination of sulphametho-xazole and
trimethoprim (TMP-SMZ), cephalexin, ceftriaxone, cefotaxime, ceftazidime,
gentamycin, amikacin and ciprofloxacin. Multi-drug resistance was defined
when resistance to at least three different groups of antibiotics was
apparent.
When early and late study periods were compared
increasing trends in bacterial resistance patterns were observed towards
TMP-SMX, 2 nd and 3rd
generation cephalosporins and gentamicin as well as in multidrug
resistance, while a decreasing trend was seen towards amikacin and
unchanged towards ciprofloxacin (Table I). The majority of
ESBL (+) E. coli strains were multi-resistant (56.5 % in early and
66.23% in late period), while only 3.4% and 5.6% of ESBL (-) strains,
respectively.
TABLE I Clinical Characteristics In The Two Study Periods
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2005-2007 |
2008-2009 |
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(n=136) |
(n=275) |
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Gender , M/F (%) |
51.5/48.5 |
55.3/44.7 |
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Age (months) |
3 (0.5-9.0) |
4.5 (1.0-7.5) |
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ESBL (+) UTI (%) |
23.5 |
63.6 |
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Abnormal renal US (%) |
37.4 |
26.7 |
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VUR (%) |
31.7 (63) |
29 (158) |
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Urinary pathogens (%) |
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E.coli |
82.3 |
88.0 |
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Klebsiella |
6.1 |
7.3 |
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Enterococcus |
3.7 |
2.5 |
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In vitro resistance (%) |
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Ampicillin |
85.8 |
98.0 |
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TMP-SMZ* |
38.5 |
59.2 |
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Cephalexin* |
30.8 |
69.3 |
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Cephrtiaxone* |
34.0 |
67.0 |
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Cefotaxime* |
26.5 |
65.0 |
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Ceftazidime* |
42.6 |
62.7 |
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Gentamicin* |
33.1 |
56.3 |
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Amikacin$ |
17.9 |
8.5 |
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Ciprofloxacin |
0.9 |
0.9 |
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Multidrug resistance# |
16.9 |
44.7 |
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US, Ultrasound; TMP-SMZ co-trimoxazoles, VUR, vesicoureteral reflux;
ESBL (+) UTI, Urinary tract infections caused by ESBL-producing
microorganisms; 2005-2007 vs 2008-2009 Pratice: * <0.001; # <0.01;
$<0.05. |
In poor and underdeveloped countries, overall
prevalence of antimicrobial resistance is notably high, reflecting
irrational and inordinate use of anti-microbial agents
[3]. We observed about 50% resistance towards TMP/SMX
in this study, similar to that reported in Turkey [4], Greece [5], England
[6], Belgium [7] and Taiwan [3], but less common than in Cambodia [8],
Central African Republic [9] and Pakistan [10]. Thus, the use of TMP-SMZ
as a single agent for empiric treatment of pediatric UTI would not cover
half of the uropathogens. We also found increased resistance towards
gentamicin, while amikacin remained suitable for empiric treatment of
acute pyelonephritis. In general, we observed the striking increasing
trend for ESBL (+) and for multi-drug-resistant uropathogens during the
late study period compared to the early period. The increased uropathogen
resistance trend demonstrated by our study could be linked to
non-restricted use of antibiotics in Serbia by physicians as well as to
high degree of self-medication in the population.
Acknowledgment: The study was supported by
the Ministry of Science and Environmental Protection, Government of
Serbia, grant no. 175079.
References
1. Goulthard MC, Veber I, Jani JC, Lawson GR, Stuart
CA, Sharma V, et al. Can prompt treatment of childhood UTI prevent
kidney scarring? Pediatr Nephrol. 2009;24:2059-63.
2. Prelog M, Schiefecker D, Fille M, Wurzner R, Brunner
A, Zimmerhackl LB. Febrile urinary tract infection in children: Ampicillin
and trimethoprim insufficient as empiric mono-therapy. Pediatr Nephrol.
2008;23:597-602.
3. Tseng MH, Lo WT, Lin WJ, Teng CS, Chu ML, Wang CC.
Changing trend in antimicrobial resistance of pediatric uropathogens in
Taiwan. Pediatric Internatonal. 2008;50:797-800.
4. Catal F, Bavbek N, Bayrak O, Odemis E, Uz E.
Antimicrobial resistance patterns of urinary tract pathogens and rationale
for empiric therapy in Turkish children for the years 2000-2006. Int Urol
Nephrol. 2009;42:953-7.
5. Anatoliotaki M, Galanakis E, Schinaki A, Stefanaki
S, Mavrokosta M, Tsilimigaki A. Antimicrobial resistance of urinary tract
pathogens in children in Crete, Greece. Scand J Infect Dis. 2007;39:671–5.
6. Bean DC, Krahe D, Wareham DW. Antimicrobial
resistance in community and nosocomial Escherichia coli urinary isolates,
London 2005-2006. Ann Clin Antimicrob. 2008;7:13-20.
7. Ladhani S, Gransden W. Increasing antibiotic
resistance among urinary tract isolates. Arch Dis Child. 2003;88:444–5.
8. RuppÎ E, Hem S, Lath S, Gautier V, Ariey F, Sarathou
JL , et al. CTX-M I2-lactamases in Escherichia coli from
Community-acquired urinary tract infections, Cambodia. Emerg Infect Dis.
2009;15:741-8.
9. Bercion R, Mossorokpinde D, Manirakiza A, La Faou A.
Increasing prevalence of antimicrobial resistance among Enterobacteriaceae
uropathogens in Bangui, Central African Republic. J Infect Developing
Countries. 2009;3:187-90.
10. Thaver D, Ali SA, Zaidi AK. Antimicrobial
resistance among neonatal pathogens in developing countries. Pediatr
Infect Dis J. 2009;28:S19-21.
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