ESPN 50th Annual Meeting

ESPN 2017


 
FACTORS THAT INFLUENCE ANTIBIOTIC RESISTANCE OF E. COLI URINARY TRACT INFECTIONS
ANA RAQUEL MENDES 1 LILIANA TEIXEIRA 1 RAQUEL OLIVEIRA 2 LIANE CORREIA-COSTA 3 LILIANA ROCHA 3 PAULA PIRES 3

1- DEPARTMENT OF PEDIATRICS, CENTRO MATERNO-INFANTIL DO NORTE, CENTRO HOSPITALAR DO PORTO, E.P.E., PORTUGAL
2- DEPARTMENT OF PEDIATRICS, UNIDADE LOCAL DE SA├║DE DO ALTO MINHO, VIANA DO CASTELO, PORTUGAL
3- DEPARTMENT OF PEDIATRIC NEPHROLOGY, CENTRO MATERNO-INFANTIL DO NORTE, CENTRO HOSPITALAR DO PORTO, E.P.E., PORTUGAL
 
Introduction:

The authors aimed to analyze the influence of age, presence of uropathy, vesicoureteral reflux (VUR), antibiotic prophylaxis and previous urinary tract infection (UTI) on antibiotic resistance of E. coli UTI. 

Material and methods:

Retrospective analysis of positive urine culture results from children and adolescents aged <18 years in a tertiary hospital in 2015. Children submitted to renal transplant, with asymptomatic UTI or neuropathic bladder were excluded from the analysis. Statistical comparisons between categorical variables were performed by chi-square tests.

Results:

A total of 219 positive urine cultures were analyzed, corresponding to 174 patients (68.4% female) with a median age of 3 years. The most common pathogens identified were E. coli (69.4%), P. mirabilis (13.7%), E. faecalis (5%) and K. pneumoniae (4.6%). Considering only the group with E. coli infections (n=94), 40.4% of children presented an uropathy, being VUR (21.6%) and primary hydronephrosis (18.6%) the most common. E. coli antibiotic resistance was higher for ampicillin (56%), fosfomycin (33.3%), trimethoprim-sulfamethoxazole (30.8%), nitrofurantoin (23%), amoxicillin/clavulanic acid (20.2%) and cefuroxime (6.6%). Regarding age distribution, amoxicillin/clavulanic acid resistance was higher among children aged 3mo-3yr, and >3yr (51.6% vs. 45.2%, p=0.034), while trimethoprim-sulfamethoxazole resistance was highest in children >3yr (62.2%, p=0.048). Resistance to trimethoprim-sulfamethoxazole was higher in children with uropathy (57.7% vs. 42.3%, p=0.035) and lower in those under prophylaxis (25% vs. 75%, p=0.001). Children under prophylaxis had a low resistance to cefuroxime (13.3% vs. 2.2%, p=0.024). The presence of uropathy, VUR, prophylaxis and a previous UTI had no impact on ampicillin and amoxicillin/clavulanic acid E. coli resistance.

Conclusions:

Amoxicillin/clavulanic acid and second generation cephalosporins are the drugs of choice in many centers. As none of the factors analyzed in the present study seemed to have an impact on the sensitivity of E. coli UTI to these group of drugs, the authors conclude that these agents remain an adequate choice.