Antibiotic Resistance In Children Research Articles

Increasing Burden of Antibiotic Resistance in Children Suffering from Septicemia in Tertiary Care Hospitals

Abstract Introduction/Objective Invasion of the bloodstream by microorganisms constitutes one of the most serious situations in infectious disease. Children are the most susceptible groups to contract diseases specifically Blood Stream Infections (BSIs). BSIs have been considered to be the main cause of morbidity and mortality in children. It is associated with a high mortality rate of 20%–50%. The emerging causative agents and resistance to various antimicrobial agents are increasing from time to time. Methods/Case Report The present study was carried out to confirm the causative agents and their antibacterial susceptibility pattern in children with septicemia at Tertiary Care Hospitals, Peshawar, KP, Pakistan. This cross- sectional study involved about 873 pediatric patients (≤ 13 years). BACTEC BD 9050 system was used to identify the causative organism, and sub-cultures were done on MacConkey Agar and Blood Agar. The antibiotic susceptibility test was done using the Kirby Bauer Disk diffusion method as per CLSI guidelines. Results (if a Case Study enter NA) Among 873 study subjects 568 (65.06 %) were males followed by 305 (34.93 %) females. Out of the 873 tested blood samples, blood cultures were positive in 83 (9.51%) followed by 122 (13.98%) skin contaminants, and no growth was observed in 668 (76.51%) cases. The majority 43 (51.80 %) of them were neonates (≤ 28 days). Gram-positive and Gram-negative bacteria constituted 58 (69.87%) and 25 (30.13%), respectively. The most frequent pathogen found was Staphylococcus aureus 54 (65.06 %), followed by Klebsiella spp., E. coli, and Pseudomonas aeruginosa 6 (7.22 %), Salmonella spp. 5 (6.02 %) Enterococcus faecalis 3 (3.61 %), Acinetobacter baumannii 2 (2.40 %) and Staphylococcus epidermidis 1 (1.20 %). In Staphylococcus aureus about 6 (11.11) were MRSA. The majority of bacterial isolates showed high resistance to Ciprofloxacin, Ceftazidime, Cefuroxime, Co-trimoxazole, Cefepime, Cefotaxime, Minocycline, Tobramycin, Cefoxitin and Cephradine that are commonly used in the study area. Conclusion The majority of the isolates were multidrug resistant. These higher percentages of multi-drug resistant emerged isolates urge us to take infection prevention measures and to conduct other large studies for appropriate empiric antibiotic choice.

Clinical Perspective of Antimicrobial Drugs in Pediatric Dentistry- An Update

Abstract This review highlights the importance of judicious antibiotic prescribing practices for orofacial infections in pediatric patients. It emphasizes the need to adhere strictly to guidelines to mitigate the rising threat of antibiotic resistance. Antibiotics, alongside analgesics, are commonly prescribed by dentists due to their efficacy in treating infections. However, a significant portion of antibiotic prescriptions are unnecessary, contributing to the development of microbial resistance. Research indicates a concerning trend of low adherence to professional clinical guidelines among dental students, dentists, and pediatric dentists regarding antibiotic prescriptions. Despite the historical success of antibiotics in dental treatments, their overuse poses a risk to this achievement. Therefore, it’s crucial to limit antibiotic use to reduce the risk of resistance development. Insufficient knowledge about significant clinical indications for antibiotic prescriptions among pediatric dentists exacerbates the problem, leading to overuse and contributing to antibiotic resistance in children. Addressing this knowledge gap and promoting adherence to guidelines is essential in preserving the effectiveness of antibiotics in pediatric dental care.

Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.

Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP. This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher's exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant. The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures. Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region's bacterial resistance features.

A retrospective study of uropathogen and its antibiotic resistance among children with urinary tract infection from a single center in China

Urinary tract infection (UTI) is a well-known bacterial infection posing serious health problem in children. A retrospective study was conducted to explore the uropathogen and its antibiotic resistance in children with UTI. Data of urine culture and antimicrobial susceptibility test was collected. Consequently, 840 children were included. The overall culture-positive UTI was 458 (54.52 %) with Escherichia coli 166 (36.24 %), followed by Enterococcus faecalis 59 (12.88 %), Enterococcus faecium 70 (15.28 %) and others. They were highly resistant to the most commonly used antibiotics. In 694 children with complicated UTI, there were 8 children with fungal infection. Multiple drug resistance (MDR) was recorded in 315 (80.98 %). The overall proportion of Extended Spectrum β-Lactamase (ESβL) production was 25 (6.43 %). In 146 children with simple UTI, MDR were also detected in 47 (77.05 %). There were 6 (9.84 %) positive for ESβL production. Our study found that complicated UTI was relatively common. Escherichia coli was the most prevalent isolate, followed by Enterococcus faecium and Enterococcus faecalis. These organisms were highly resistant to the most commonly used antibiotics. Relatively high prevalence of MDR and low ESβL-producing organisms were observed.

Impact of primary duodenogastric reflux and Helicobacter pylori infection on gastritis and antibiotic resistance in children

To investigate the risk factors for Helicobacter pylori (HP) infection in children with primary duodenogastric reflux (DGR) and its impact on gastritis and antibioticresistance. A retrospective analysis was performed on the clinical data of 2 190 children who underwent upper gastrointestinal endoscopy in Wuxi Children's Hospital from January 2019 to February 2022, among whom 308 children were diagnosed with primary DGR. According to the presence or absence of HP infection, the children were classified to HP infection group (53 children) and non-HP infection group (255 children). The risk factors for HP infection and its impact on the incidence rate and severity of gastritis were analyzed. According to the presence or absence of primary DGR, 331 children with HP infection were classified to primary DGR group (29 children) and non-primary DGR group (302 children), and then the impact of primary DGR with HP infection on antibiotic resistance was analyzed. The HP infection group had a significantly higher age than the non-HP infection group (P<0.05), and there was a significant difference in the age distribution between the two groups (P<0.05), while there were no significant differences in the incidence rate and severity of gastritis between the two groups (P>0.05). The multivariate logistic regression analysis showed that older age was a risk factor for HP infection in children with DGR (P<0.05). Drug sensitivity test showed that there were no significant differences in the single and combined resistance rates of metronidazole, clarithromycin, and levofloxacin between the primary DGR group and the non-primary DGR group (P>0.05). Older age is closely associated with HP infection in children with DGR. Primary DGR with HP infection has no significant impact on gastritis and antibiotic resistance in children.

Aerobic Microbiological Spectrum and Antibiotic Resistance in Children Operated for Anorectal Abscesses.

(1) Background: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. (2) Methods: We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010-2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin-methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l'Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer-Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. (3) Results: Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. Escherichia coli, Klebsiella pneumoniae complex, and Proteus mirabilis were the most frequently isolated. In addition, Staphylococcus aureus was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. (4) Conclusions: The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated.

Antibiotic Resistance in Children with Urinary Tract Infection at Al-Mahmodyiah General Hospital: Descriptive Study

Antibiotic Resistance in Children with Urinary Tract Infection at Al-Mahmodyiah General Hospital: Descriptive Study

Bacterial Agents and Antibiotic Resistance Profile in Pyelonephritis; A Comparison between Children with and without Urinary Tract Abnormalities in the North of Iran

Background: Pyelonephritis in children is a serious condition that is commonly encountered in clinical practice. Urinary tract abnormalities increase the risk of urinary tract infections (UTIs) and consequently antibiotic resistance. Our study aimed to evaluate the local trend in terms of bacterial uropathogen resistance in Babol, Iran, in children with pyelonephritis considering urinary tract abnormalities.&#x0D; Methods: We recruited pediatric cases aged 1 month to 18 years who were admitted to Amirkola hospital with a diagnosis of pyelonephritis from 2016 to 2019. Children with negative urine cultures or incomplete imaging were excluded from the study. Causative agents were identified based on biochemical features. Antimicrobial in vitro resistance tests were performed using the disk diffusion agar test.&#x0D; Results: A total of 105 children were included in the study. E. coli was the most common causative agent found in 93 (88.6%) patients. Most of the bacterial isolates were sensitive to amikacin and imipenem, and only 12.4% and 13.3% of isolates were resistant to this antibiotic. On the other hand, nalidixic acid represented the least effective treatment, with a resistance rate of 88.6%. A statistically significant difference was observed in resistance to nitrofurantoin and nalidixic acid between children with and without anomalies (p &lt; 0.05).&#x0D; Conclusion: High antibiotic resistance, especially in children with urinary tract anomalies, was identified for frequently used antibiotics. Our findings provide important implications regarding local patterns of uropathogens and antibiotic resistance in children with pyelonephritis.

Colonization, Density, and Antibiotic Resistance of Streptococcus pneumoniae, Haemophilus Influenzae, and Moraxella catarrhalis among PCV13-Vaccinated Infants in the First Six Months of Life in Rochester, New York: A Cohort Study.

Streptococcus pneumoniae (Spn), Haemophilus influenzae (Hflu), and Moraxella catarrhalis (Mcat) nasopharyngeal colonization precedes disease pathogenesis and varies among settings and countries. We sought to assess colonization prevalence, density, Spn serotypes, and antibiotic resistance in children in the first 6 months of life in pediatric primary care settings. Prospective cohort study in Rochester, NY during 2018-2020. Nasopharyngeal swabs were collected from 101 children at age 1, 2, and 3 weeks, then 1, 2, 4, 6, 9, 12, 15, 18, and 24 months. Spn serotypes were determined by Quellung. Oxacillin resistance for Spn and β-lactamase production by Hflu and Mcat was tested. All children received PCV13 vaccine according to U.S. recommended schedule. Spn, Hflu, and Mcat colonization was detected in only 5% of infants before age 2 months old. Cumulative prevalence was 34% for Spn, 10% for Hflu, and 53% for Mcat in children ≤6 months of age. Nasopharyngeal bacterial density of Spn, Hflu, and Mcat (x = 2.71 log) in children ≤6 months of age was lower than at 7-24 months of age (x = 3.15 log, p < 0.0001). Predominant serotypes detected ≤6 months of age were 23B (16.7%), 22F (12.9%), 15B/C (11%), and 16F (9.2%). In total, 14.8% of Spn isolates were oxacillin resistant and 66.7% of Hflu isolates were β-lactamase producing. Spn, Hflu, and Mcat nasopharyngeal colonization was uncommon and of low density among children ≤6 months old, especially among children <2 months of age. Non-PCV13 serotypes predominated and a different serotype distribution was observed in ≤6-month olds compared to 7- to 24-month olds.

Проблемы антибиотикорезистентности у детей после трансплантации печени

These days, the “craze” for antibiotics has become like an epidemic and today, antibiotic resistance is a global problem. Objective.To study antibiotic resistance in children before and after surgery. Material and methods: Since March 2016, 32 liver transplants have been performed in children (from 6 months to 8 years). Of these, 23 (78.1%) patients with biliary atresia, 2 (6.2%) with cirrhosis of the liver in the outcome of autoimmune hepatitis, 1 (3.1%) with primary hyperoxaluria, 1 (3.1%) with cholangiocarcinoma, 1 (3,1%), 1 (3,1%) with inoperable hepatoblastoma, 1 (3.1%) cirrhosis of the liver in the outcome of viral hepatitis C . The number of girls was 17 (53.1%) and boys 15 (46.9%). Results:There was a 100% antibiotic intake in the preoperative period.When cross-testing design, 5 (15.6%) children with Klebsiella sepsis and with a fatal outcome were resistant to all groups of antibacterial drugs. Ethical issues: The study was conducted in accordance with the current version of the Declaration of Helsinki, in accordance with the Standard of Good Clinical Practice (GCP) (Appendix 2 to the order of the Acting Minister of Health of the Republic of Kazakhstan dated February 4, 2021 No. RK DSM-15). Conclusion. Antibiotic resistance is a major threat to global health and sustainable development, the principles of which were defined in the 2030 Agenda and the Sustainable Development Goals. It is estimated that, in the absence of effective interventions, the development of antimicrobial resistance could lead to a global death’s will increase by about 10 million cases annually. Growing concerns about antibiotic resistance have led to the adoption of a number of national, regional and global action plans in recent years to raise awareness, promote research and optimize antimicrobial use and access. Global initiatives also highlight the importance of more effective and sustainable investment in technology development and intersectoral action.

Risk of community- and hospital-acquired bacteremia and profile of antibiotic resistance in children hospitalized with severe acute malnutrition in Niger

ObjectiveTo estimate the prevalence and antibiotic resistance profile of community- and hospital-acquired bacteremia among hospitalized children with severe acute malnutrition in Niger. MethodsA descriptive, longitudinal study was conducted in an intensive nutritional rehabilitation center in Madarounfa, Niger. Children aged 6 to 59 months admitted for inpatient treatment of complicated severe acute malnutrition (n=2187) had blood specimens drawn at admission to assess prevalence of community-acquired bacteremia. Subsequent specimens were drawn per physician discretion to assess incidence of hospital-acquired bacteremia. Antibiotic susceptibility testing was performed on positive blood cultures. ResultsThe prevalence of community-acquired bacteremia at admission was at least 9.1% (95% confidence interval [CI]: 8.1, 10.4%), with non-typhoid Salmonella identified in over half (57.8%) of cases. The cumulative incidence of hospital-acquired bacteremia was estimated at 1.2% (95% CI: 0.8, 1.7%), among which the most common organisms were Klebsiella pneumoniae (19.4%), Acinetobacter baumannii (16.1%), Enterococcus faecalis (12.9%), and Escherichia coli (12.9%). In community-acquired bacteremia, 58% cases were resistant to amoxicillin-clavulanate; 100% of hospital-acquired bacteremia cases were resistant to amoxicillin and amoxicillin-clavulanate. Mortality risk was elevated among children with hospital-acquired bacteremia (risk ratio [RR] = 9.32) and community-acquired bacteremia (RR = 2.67). ConclusionBacteremia was a significant contributor to mortality. Antibiotic resistance poses a challenge to effective clinical management of severe acute malnutrition.

Increased Antibiotic Resistance in Children with Helicobacter pylori Infection: A Retrospective Study.

Children with recurrent abdominal pain may be suffering from a Helicobacter pylori (HP) infection. The gold standard for confirming HP gastritis is histological evaluation and microbiological tests performed on specimens collected by esophagogastroduodenoscopy (EGD). The aim of this study was to analyze HP positive cultures and antibiograms with regard to clinical and histopathological correlates. The data of 124 subjects with frequent gastrointestinal symptoms who underwent an EGD were retrospectively collected and analyzed. The mean age of the patients was 13 ± 3.6 years. The most frequent complaints were epigastric pain (84%; n = 100/119) and dyspepsia (79%; n = 94/119). HP gastritis was diagnosed in 54% (n = 67). Interestingly, 40% (n = 49) of the isolates were resistant to at least one antibiotic: amoxicillin (20%; n = 10/49), clarithromycin (45%; n = 22/49), or metronidazole (59%; n = 29/49). Isolates were resistant to two or more antibiotics in 16% (n = 20) of cases. In conclusion, we revealed remarkably high resistance rates to amoxicillin, metronidazole, and clarithromycin in our cohort. The presence of antibiotic resistance to more than one antibiotic was substantially increased in our HP-infected patients and this may negatively affect eradication treatment.

Modern View of the Problem of Antibiotic Resistance in Children before and after Liver Transplantation, Causes of Antibiotic Resistance

Modern View of the Problem of Antibiotic Resistance in Children before and after Liver Transplantation, Causes of Antibiotic Resistance

Prevalence and antibiotic resistance of uropathogens in children with urinary tract infections referring to Abuzar hospital in Ahvaz

Urinary tract infection (UTI) is a prevalent disease among children. This study is an attempt to find the bacterial agents of UTI and antibiotic resistance in children. A descriptive cross-sectional study was carried out on 1316 clinical samples of children at Abuzar Hospital in Ahvaz that had positive urine culture. The strains were determined through biochemical tests and differential culture media. The pattern of antibiotic resistance of the studied strains was determined by the disk diffusion method. Out of the 1316 children surveyed, 821 were girls and 495 were boys. The most isolated strains from urine cultures were Escherichia coli (57.52%) followed by Enterococcus (12.15%). E. coli isolates demonstrated the highest resistance to ampicillin (57.06%) and amikacin was recognized as the most effective antibiotic with a sensitivity of 91.94%. E. coli was the most common causative agent of UTI in children. Amikacin was recognized as the appropriate choice against urinary tract pathogens. Because, in different regions and over time, the frequency distribution of antibiotic resistance varies, it is recommended to carry out periodic monitoring of antibiotic resistance for infection control.

Prevalence, Clinical Characteristics and Changes of Antibiotic Resistance in Children with Nontyphoidal Salmonella Infections from 2009-2018 in Chongqing, China.

PurposeNontyphoidal Salmonella (NTS) is a leading bacterial cause for acute gastroenteritis in children. With the increasing use of antibiotics worldwide, antibiotic resistance has become a global problem. However, data on NTS infections and changes in antibiotic resistance among children remain limited in China. We aimed to characterize the prevalence, clinical feature, serotype and the changes of antibiotic resistance of NTS in children in Chongqing.Methods501 hospitalized children with NTS infections (confirmed by positive NTS culture) in Children’s Hospital of Chongqing Medical University from January 2009 to December 2018 were included. The clinical data and drug sensitivity test results were retrospectively reviewed and analyzed. Antibiotic resistance in NTS infections was compared between 2009–2013 and 2014–2018.ResultsA total of 501 isolates were detected. Most NTS infections occurred in children under three years old, which mainly occurred between July and October. The numbers of patients with diarrhea, fever, and vomiting were 472 (94.2%), 422 (84.2%) and 146 (29.1%), respectively. Serogroup B (67.5%) was the predominant serogroup isolates. And Salmonella Typhimurium was the most common serotype (79.2%). The study compared the drug resistance of NTS from 2009 to 2013 with that from 2014 to 2018. We found the drug resistance rates of NTS to cefazolin, cefotaxime, ciprofloxacin, levofloxacin and imipenem showed an upward trend. The drug resistance rates of NTS to chloramphenicol, ampicillin, ceftriaxone, cefepime and compound sulfamethoxazole decreased slightly, but still showed high drug resistance rates. And drug resistance rates of NTS to piperacillin/tazobactam and ceftazidime decreased significantly in the last ten years. Multi-drug resistance (MDR) isolates, were detected among 69 cases (13.7%) of 501 children with NTS infections.ConclusionThe overall antibiotic resistance rates remained at a high level in Chongqing. Continuous surveillance of antibiotic resistance in NTS and control measures such as avoiding unnecessary antibiotic therapy in general NTS gastroenteritis are important. For severe or invasive infections caused by NTS infection in Southwest China, the use of ceftazidime is recommended until antibiotic sensitivity test results are available. And the choice of antibiotics should be based on the curative effect and the antibiotics sensitivity results.

Rapid Molecular Tests for Detecting Respiratory Pathogens Reduced the Use of Antibiotics in Children.

Multiplex polymerase chain reaction (mPCR) is increasingly being used to diagnose infections caused by respiratory pathogens in pediatric inpatient facilities. mPCR assays detect a broader array of viruses, with higher specificity and sensitivity and faster turnaround than previous assays. We adapted the FilmArray Respiratory Panel (FA-RP) for diagnosing respiratory infections. FA-RP is an in vitro mPCR assay that simultaneously and rapidly (in about 1 h) detects 20 pathogens directly from respiratory specimens. Here, we studied the clinical efficacy of FA-RP in children who underwent testing for respiratory pathogens at Yeungnam University Hospital from November 2015 to August 2018. From November 2015 to June 2016, routine mPCR testing was performed on nasopharyngeal swabs using the routine mPCR kit. From November 2016 to July 2018, mPCR testing was performed using FA-RP. A total of 321 tests by routine mPCR and 594 tests by FA-RP were included. The positive detection rates for routine mPCR and FA-RP were 71.3% and 83.3%, respectively. FA-RP reduced the lead time, waiting time, turnaround time, intravenous (IV) antibiotic use, and length of hospital stay for pediatric patients. The decreased use of antibiotics is expected to reduce antibiotic resistance in children.

Analysis of Predictive Factors of Antibiotic Resistant Pseudomonas aeruginosa in Children with Acute Appendicitis

Objectives: To analyze the antibiotic resistance in children with acute appendicitis caused by Pseudomonas aeruginosa (P. aeruginosa), and to explore the predictors of infection and antibiotic resistance in children with acute appendicitis through blood biochemical indicators Methods: Fifty control children (with no bacteria detected in the culture) and 103 children with P. aeruginosa infection who were admitted to the general surgery department of Jiangxi children’s hospital and treated surgically from January 2015 to June 2019 were analyzed. Results: Cefotaxime, cotrimoxazole and tetracycline had the highest drug resistance rates in children with appendicitis caused by P. aeruginosa, with (93.20%, 96/103), (93.20%, 96/103) and (93.20%, 96/103), respectively. There were significant pattern differences between the P. aeruginosa infected group and penicillin antibiotics resistant group. The combination of glutamyltranspeptidase (GGT), phosphorus (P), free fatty acid (FFA) and fibrinogen (CFbg) could effectively identify whether children with acute appendicitis were infected by P. aeruginosa and whether they were resistant to penicillin antibiotics. For the control group and P. aeruginosa infected group, area under the receiver operating characteristic (AUROC) value of the four indicators was 0.9034 (95% CI, 0.8514 - 0.9555), with a sensitivity and specificity of 84.76% and 87.93%, respectively. For the group with or without penicillin antibiotics resistance, the AUROC value was 0.9341 (95% CI, 0.8681 - 1.0000), with a sensitivity and specificity of 89.04% and 96.88%, respectively. Conclusions: Clinical blood biochemical indicators can reflect bacterial infection and antibiotic resistance in children with acute appendicitis to a certain extent, and the combination of GGT, P, FFA, and CFbg can predict P. aeruginosa infection and penicillin antibiotics resistance in children with acute appendicitis.

Interventions to reduce Staphylococcus aureus in the management of eczema.

Interventions to reduce Staphylococcus aureus in the management of eczema.

Analysis of antibiotic resistance and influencing factors for Helicobacter pylori in children

Objective To investigate the antibiotic resistance of Helicobacter pylori(Hp) isolates cultured from endoscopic gastric mucosal samples and influencing factors for antibiotic resistance in children. Methods From April 2013 to February 2016, Hp cultured from mucosa samples of the gastric antrum and the body of stomach was investigated in 246 patients with 13C breath test positive examined by gastroscopy.Resistance to Amoxicillin, Clarithromycin, Metronidazole, Tetracycline was tested for Hp by using E-test.The clinical data were collected from the patients, and the relationship among age, gender, endoscopic diagnosis, histological performance, eradication number factors and antibiotic resistance rate were analyzed. Results Of 246 specimens, 174 cases (70.7%) were positive.The overall antibiotic resistance rates of isolates obtained were 96.55% (168/174 cases), 57.47% (100/174 cases), 4.02% (7/174 cases), 1.15%(2/174 cases) with respect to Clarithromycin, Metronidazole, Tetracycline and Amoxicillin.An antibiotic resistance rate was 43.10% (75/174 strains), among which the Clarithromycin resistance rate was 93.33% (70/75 strains), and the Metronidazole resistance rate was 6.67% (5/75 strains). Double resistance rate was of 54.02%(94/174 strains), among which the resistances rate of Clarithromycin+ Metronidazole was 52.30%(91/94 strains), and the resistances rate of Clarithromycin+ Tetracycline was 1.72%(3/94 strains). Triple resistance rate of Clarithromycin+ Metronidazole+ Tetracycline was 1.15%(2/174 strains). Quadruple resistance rate of Clarithromycin+ Metronidazole+ Amoxicillin+ Tetracycline was 1.15%(2/174 strains). Factor analysis showed that the resistance rate of Clarithromycin in children who had failed in eradication therapy [98.7%(148/150 cases)] was higher than that in children who had not undergone eradication therapy [83.3%(20/24 cases)], and the difference was statistically significant(χ2=14.610, P 0.05). Conclusions Hp resistance rate to Clarithromycin, Metronidazole is very high in children, but it is relatively low to Amoxicillin and Tetracycline, and multiple antibiotic resistance is at high prevalence. Key words: Helicobacter pylori; Antibiotic resistance; Child

Relationship between urinalysis findings and responsible pathogens in children with urinary tract infections

Pyuria, presence of bacteria, leukocyte esterase, and nitrite positivity in urinalysis should be considered together, and simultaneous urine culture test should be performed in the diagnostic evaluation of urinary tract infection (UTI). The absence of pyuria in urinalysis cannot exclude UTI in patients with suggestive clinical findings. It was aimed to assess relationship between urinalysis tests and uropathogen and to evaluate antibiotic resistance in children. The study included patients (aged 0-18 years) with significant uropathogen growth in urine culture tests. The patients' data regarding age, gender, results of urine microscopy, urine culture, and antibiogram were recorded retrospectively. Overall, 705 patients (562 girls, 143 boys) with significant growth in urine culture test were included. Median age was 72 months among girls and 12 months among boys. Most common uropathogens were Escherichia coli (79.6%) and Klebsiella pneumoniae (8.2%). E. coli was more commonly among girls (87%) and Klebsiella spp. among boys (53.3%). Pyuria was positive in urinalysis in 75% of patients. Pyuria presence was more common in patients with E.coli or Proteus spp. (80.6% and 71.4%, respectively) than those with Enterococcus spp. and Klebsiella spp. (52.0% and 53.3%, respectively). In culture antibiogram tests, ampicillin resistance was 100% in Klebsiella oxytoca and Enterobacter spp. and 72% in E. coli strains. No ceftriaxone resistance was observed in K. oxytoca, Citrobacter spp., Pseudomonas aeruginosa, and Enterobacter spp. Most UTIs were seen in older girls. Pyuria might be lacking in UTIs associated to Klebsiella spp. and Enterococcus spp., and absence of pyuria may not exclude UTI in patients with compatible clinical findings. Ceftriaxone is still an option in empirical treatment; unnecessary use of third-generation cephalosporins should be avoided, particularly in infections other than UTI. It was found that E. coli more commonly caused leukocyturia, leukocyte esterase positivity, and pyuria; that pyuria might be lacking in UTIs associated to Klebsiella spp. and Enterococcus spp. and that pyuria was more prevalent among girls. It is though that urine culture tests should be performed in children with suspected UTI even in the absence of pyuria because lack of pyuria may lead delay in diagnosis and treatment as well as renal scar formation.