The influence of antibiotic prophylaxis on bacterial resistance in urinary tract infections in children with spina bifida

Sebastiaan Hermanus Johannes Zegers,Tjomme Van Der Bruggen,Jan Kimpen,Jeanne Dieleman,Catharine De Jong-De Vos Van Steenwijk

doi:10.1186/s12879-016-2166-y

Abstract

BackgroundBacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP.MethodsIn a cohort of 176 spina bifida patients, 88 continued and 88 stopped using AP. During 18 months, a fortnightly catheterized urine sample for bacterial pathogens was cultured. UTIs and significant bacteriuria (SBU) were defined as a positive culture with a single species of bacteria, respectively with and without clinical symptoms and leukocyturia. We compared the percentage of resistance to commonly used antibiotics in the isolated bacteria in both groups.ResultsIn a total of 4917 cultures, 713 (14.5%) had a positive monoculture, 54.3% of which were Escherichia coli. In the group stopping AP, the resistance percentage to antibiotics in UTI / SBU bacteria was lower than in the group remaining on AP, even when excluding the administered prophylaxis.ConclusionStopping antibiotic prophylaxis for urinary tract infections is associated with reduced bacterial resistance to antibiotics in children with spina bifida.Trial registrationISRCTN ISRCTN56278131. Registered 20 December 2005.

Highlights

Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades
Patients All patients with a meningomyelocele known at the outpatient clinics of Wilhelmina’s Children’s Hospital in Utrecht, the Netherlands and Gasthuisberg University Hospital in Leuven, Belgium were eligible for inclusion in the study, provided they had been on clean intermittent bladder catheterization (CIC) and antibiotic prophylaxis (AP) during the last 6 months
To avoid repeated calculations for bacterial resistance patterns on one period of persistent significant bacteriuria (SBU), we considered multiple consecutive positive cultures (SBU) without clinical signs of Urinary tract infection (UTI), and no antibiotic treatment, as one ongoing colonization

Summary

Introduction

Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP. Prior to the recent AAP Guidelines, there has been a trend to prescribe antibiotic prophylaxis (AP) to prevent recurrence of urinary tract infections (UTIs) and possible subsequent renal parenchymal scarring in otherwise healthy children and children with congenital abnormalities of kidney and urological tract [1]. The introduction of clean intermittent bladder catheterization (CIC) in 1972 by Lapides et al enabled more adequate bladder emptying and a significant decline in UTIs, renal insufficiency and the need for kidney transplantation [7]. Due to the lack of general guidelines on the use of AP for children with spina bifida applying CIC [11], caretakers were guided by the clinical course in the individual patient to either continue or stop AP

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Conclusion