Antibiotic treatment and antimicrobial resistance in children with urinary tract infections

K Vazouras; K Velali; I Tassiou; A Anastasiou-Katsiardani; K Athanasopoulou; A Barbouni; C Jackson; L Folgori; T Zaoutis; R Basmaci; Y Hsia

doi:10.1016/j.jgar.2019.06.016

Antibiotic treatment and antimicrobial resistance in children with urinary tract infections

J Glob Antimicrob Resist. 2020 Mar:20:4-10. doi: 10.1016/j.jgar.2019.06.016. Epub 2019 Jun 25.

Authors

K Vazouras¹, K Velali², I Tassiou³, A Anastasiou-Katsiardani⁴, K Athanasopoulou⁵, A Barbouni⁶, C Jackson⁷, L Folgori⁸, T Zaoutis⁹, R Basmaci¹⁰, Y Hsia¹¹

Affiliations

¹ The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens, Athens, Greece; Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London SW17 0RE, UK; Second Department of Pediatrics, Aghia Sophia Children΄s Hospital, Agia Sophia Hospital, Goudi, Athens, Greece. Electronic address: k.vazouras@cleoresearch.org.
² First Department of Pediatrics, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
³ Paediatrics Department, University Hospital of Larissa, Larissa, Greece.
⁴ Paediatrics Department, Achillopouleion General Hospital of Volos, Volos, Greece.
⁵ Microbiology Department, Achillopouleion General Hospital of Volos, Volos, Greece.
⁶ Department of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece.
⁷ Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London SW17 0RE, UK.
⁸ Paediatric Infectious Disease Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy.
⁹ The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens, Athens, Greece; Division of Infectious Diseases, Children's Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, PA, USA.
¹⁰ Université de Paris, Infection, Antimicrobiens, Modélisation, Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé Et de la Recherche Médicale, F-75018 Paris, France; Service de Pédiatrie-Urgences, Hôpital Louis-Mourier, Assistance Publique - Hôpitaux de Paris, F-92700 Colombes, France.
¹¹ Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London SW17 0RE, UK; School of Pharmacy, Queen's University Belfast, Belfast, UK.

PMID: 31252156
DOI: 10.1016/j.jgar.2019.06.016

Abstract

Objectives: The aim of this study was to describe antibiotic prescribing patterns and antimicrobial resistance rates in hospitalised children with febrile and afebrile urinary tract infections (UTIs).

Methods: Antibiotic prescriptions and antibiograms for neonates, infants and older children with UTI admitted to a general district hospital in Central Greece were evaluated. Data covering a 5-year period were collected retrospectively from the Paediatric Department's Electronic Clinical Archive. Patients were included based on clinical and microbiological criteria. Antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method.

Results: A total of 230 patients were included in the study. Among 459 prescriptions identified, amikacin (31.2%) was the most common antibiotic prescribed in this population, followed by amoxicillin/clavulanic acid (17.4%) and ampicillin (13.5%). Children received prolonged intravenous (i.v.) treatments for febrile (mean ± S.D., 5.4 ± 1.45 days) and afebrile UTIs (mean ± S.D., 4.4 ± 1.64 days). A total of 236 pathogens were isolated. The main causative organism was Escherichia coli (79.2%) with high reported resistance rates to ampicillin (42.0%), trimethoprim/sulfamethoxazole (26.5%) and amoxicillin/clavulanic acid (12.2%); lower resistance rates were identified for third-generation cephalosporins (1.7%), nitrofurantoin (2.3%), ciprofloxacin (1.4%) and amikacin (0.9%). Klebsiella spp. isolates were highly resistant to cefaclor (27.3%).

Conclusion: High prescribing rates for amikacin and penicillins (± β-lactamase inhibitors) and prolonged i.v. treatments were observed. Escherichia coli was highly resistant to ampicillin, whilst third-generation cephalosporins exhibited greater in vitro efficacy. Establishment of antimicrobial stewardship programmes and regular monitoring of antimicrobial resistance could help to minimise inappropriate prescribing for UTIs.

Keywords: Antibiotic prescribing; Antimicrobial resistance; Children; UTI; Urinary tract infection.

MeSH terms

Administration, Intravenous
Adolescent
Amikacin / administration & dosage*
Amikacin / pharmacology
Amoxicillin-Potassium Clavulanate Combination / administration & dosage*
Amoxicillin-Potassium Clavulanate Combination / pharmacology
Ampicillin / administration & dosage*
Ampicillin / pharmacology
Anti-Bacterial Agents / administration & dosage*
Anti-Bacterial Agents / pharmacology
Antimicrobial Stewardship
Child
Child, Preschool
Disk Diffusion Antimicrobial Tests
Drug Resistance, Multiple, Bacterial
Escherichia coli / drug effects
Escherichia coli / isolation & purification
Female
Fever / drug therapy
Fever / microbiology*
Greece
Humans
Infant
Infant, Newborn
Klebsiella / drug effects
Klebsiella / isolation & purification
Male
Retrospective Studies
Urinary Tract Infections / drug therapy*
Urinary Tract Infections / microbiology

Substances

Anti-Bacterial Agents
Amoxicillin-Potassium Clavulanate Combination
Ampicillin
Amikacin