ISSN : 2146-3123
E-ISSN : 2146-3131

Changes in Bacterial Resistance Patterns of Pediatric Urinary Tract Infections and Rationale for Empirical Antibiotic Therapy
İbrahim Gökçe1, Neslihan Çiçek1, Serçin Güven1, Ülger Altuntaş1, Neşe Bıyıklı1, Nurdan Yıldız1, Harika Alpay1
1Department of Pediatrics, Division of Pediatric Nephrology, Marmara University School of Medicine, İstanbul, Turkey
DOI : 10.4274/balkanmedj.2015.1809

Background: The causative agent spectrum and resistance patterns of urinary tract infections in children are affected by many factors.

Aims: To demonstrate antibiotic resistance in urinary tract infections and changing ratio in antibiotic resistance by years.

Study Design: Retrospective cross-sectional study.

Methods: We analysed antibiotic resistance patterns of isolated Gram (-) bacteria during the years 2011-2014 (study period 2) in children with urinary tract infections. We compared these findings with data collected in the same centre in 2001-2003 (study period 1).

Results: Four hundred and sixty-five uncomplicated community-acquired Gram (-) urinary tract infections were analysed from 2001-2003 and 400 from 2011-2014. Sixty-one percent of patients were female (1.5 girls : 1 boy). The mean age of children included in the study was 3 years and 9 months. Escherichia coli was the predominant bacteria isolated during both periods of the study (60% in study period 1 and 73% in study period 2). Bacteria other than E. coli demonstrated a higher level of resistance to all of the antimicrobials except trimethoprim-sulfamethoxazole than E. coli bacteria during the years 2011-2014. In our study, we found increasing resistance trends of urinary pathogens for cefixime (from 1% to 15%, p<0.05), amikacin (from 0% to 4%, p<0.05) and ciprofloxacin (from 0% to 3%, p<0.05) between the two periods. Urinary pathogens showed a decreasing trend for nitrofurantoin (from 17% to 7%, p=0.0001). No significant trends were detected for ampicillin (from 69% to 71%), amoxicillin-clavulanate (from 44% to 43%), cefazolin (from 39% to 32%), trimethoprim-sulfamethoxazole (from 32% to 31%), cefuroxime (from 21% to 18%) and ceftriaxone (from 10% to 14%) between the two periods (p>0.05).

Conclusion: In childhood urinary tract infections, antibiotic resistance should be evaluated periodically and empiric antimicrobial therapy should be decided according to antibiotic sensitivity results.

Keywords : Urinary tract infection, antibiotic resistance, children
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