Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract.

Ioana-Cristina Olariu,Ruxandra M. Steflea,Andrada-Mara Ardelean,Dan Ionescu,Mihai Gafencu,Iulia Cristina Bagiu,Florin George Horhat,Ramona F. Stroescu,Gabriela Doros,Adela Chirita-Emandi,Raluca Isac,Dan-Dumitru Vulcanescu,Diana-Georgiana Basaca

doi:10.3390/children8070585

Abstract

Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens’ antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.

Highlights

Urinary tract infections are one of the most common infections in children, with an estimated occurrence between 10–30% of cases [1]
We analyzed all patients diagnosed with Congenital anomalies of kidney and urinary tract (CAKUT) admitted to Emergency Hospital for Children “Louis Turcanu” in Timisoara over a 5-year period, aged
252 pediatric patients with CAKUT were admitted to our hospital

Summary

Introduction

Urinary tract infections are one of the most common infections in children, with an estimated occurrence between 10–30% of cases [1]. Some children are at increased risk of developing urinary tract infection (UTI) due to predisposing conditions including congenital abnormalities of the urinary tract favoring urine stasis [2]. In 30% of children with congenital anomalies of kidney and urinary tract (CAKUT), UTI can be the sentinel event [3]. CAKUT are a well-documented risk factor for the development of UTI in children [3]. Vesicoureteral reflux (VUR) alters the unidirectional flow of urine, while pyeloureteral junction obstruction (PUJO) leads to stasis, both increasing the risk of multiplying pathogenic microorganisms [4]. Any pathogen microorganism can cause UTI, yet bacteria are responsible for more than

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