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Cephalosporin resistant urinary tract infections in young children

Authors

  • SS Mehr,

    1. Departments of Emergency Medicine,
    2. Sunshine Hospital,
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  • CVE Powell,

    1. Departments of Emergency Medicine,
    2. Paediatrics, Microbiology and Infectious Diseases, Royal Children's Hospital,
    3. Joseph Epstein Centre Emergency Medicine Research, Western Hospital, and
    4. Department of Paediatrics, University of Melbourne, Melbourne, Australia
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  • N Curtis

    1. Paediatrics, Microbiology and Infectious Diseases, Royal Children's Hospital,
    2. Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Dr Nigel Curtis, Paediatric Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Flemington Road, Parkville, Victoria, Australia, 3052. Fax: +61 3 9345 6777; email: nigel.curtis@rch.org.au

Abstract

Objective:  To describe the antibiotic resistance pattern of bacteria causing urinary tract infection (UTI) in a cohort of Australian children under 6 years of age.

Methods:  Data were collected over a 12-month period from children under 6 years of age with a provisional diagnosis of UTI made in the Emergency Department of Sunshine Hospital, Victoria.

Results:  During the study period 100 culture-proven UTI were identified in 97 children. Three children had two episodes. Out of the 100 episodes, 39% were male, 56% were under 12 months of age at presentation and 61% were managed as outpatients. Clinical features were non-specific in the majority of cases. Hydronephrosis and vesicoureteric reflux was detected in 5.5% and 28.6%, respectively, of children with their first investigated UTI. A single bacterial isolate was cultured from 97 urines and two from three samples. Escherichia coli (n = 90) and Proteus mirabilis (n = 5) were the most common isolates. In vitro resistance to ampicillin/amoxycillin was found in 52% of isolates, to trimethoprim in 14% and to cephalothin/cephalexin in 24%. This resistance rate to first generation cephalosporins is the highest reported to date in adult or paediatric UTI in Australia.

Conclusions:  Ampicillin/amoxycillin or cephalothin/cephalexin may not be the optimal choice of antibiotic for the empiric treatment of UTI in this and possibly other paediatric populations.

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