Treatment and Antimicrobial Resistance in Children with Urinary Tract Infections

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

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

RESULTS: Two hundred and thirty 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 treatments for febrile (mean 5.4 days; SD 1.45) and afebrile UTIs (mean 4.7 days; SD 1.34). 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 3rd generation cephalosporins (1.7%), nitrofurantoin (2.3%), ciprofloxacin (1.3%) and amikacin (0.9%). Klebsiella sp. isolates were highly resistant to cefaclor (27.3%).

CONCLUSION: We observed high prescribing rates for amikacin and penicillins (+/-beta lactamase inhibitors) and prolonged intravenous treatments. E.coli appeared to be highly resistant to ampicillin, whilst 3rd generation cephalosporins exhibited higher in vitro efficacy. The establishment of antimicrobial stewardship programs and regular monitoring of antimicrobial resistance could help to minimise inappropriate prescribing for UTIs.