Oral Cephalosporin Research Articles

Pyélonéphrites à E. coli : stratégies prophylactiques

The aim of the prevention of recurrent urinary tract infections in children is to reduce renal scarring, that is associated with hypertension or end-stage renal failure decades latter. However, heterogeneity of the studies prevents clear recommendations. Recent American Academy of Pediatrics meta-analysis failed to demonstrate any effectiveness of antibioprophylaxis in the prevention of recurrent febrile urinary tract infections in infants less than 2 years of age, whatever the presence or the grade of vesicoureteral reflux. Moreover, adverse events of cotrimoxazole, which is the sole antibioprophylaxis available in France, are questionable. Long term low doses of oral cephalosporins or cotrimoxazole are known to select resistant enterobacteriae, producing extended-spectrum beta-lactamases (ESBL) especially. To date, antibioprophylaxis should be discussed with urologists depending on the patient. Other preventive measures as cranberries or pre/ probiotics, are inconclusive. Surgery (or circumcision) depends on the associated uropathy. Dysfunctional elimination syndrome is frequent and has to be recognized and treated.

Prospective Comparative Study of Two Protocols of Antibiotic Prophylaxis in Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PCNL) is considered to be a clean-contaminated surgical procedure, and all patients are recommended to receive antibiotic prophylaxis before the operation to prevent septic events. The aim of the present study is to prospectively compare two different protocols of antibiotic prophylaxis in PCNL. Seventy-three patients with preoperative sterile urine were randomized into single-dose or short-course antibiotic prophylaxis groups. Patients in the first group (n=36) were given only a single dose of ceftriaxone during induction of anesthesia, while the second group (n=37) were given an oral third-generation cephalosporin after ceftriaxone until nephrostomy catheter withdrawal. For each patient, urine samples that were taken during initial access into the collecting system, as well as some stone fragments, were sent for culture and sensitivity analysis. Moreover, urine samples of the patients were cultured preceding nephrostomy catheter removal. Occurrence of perioperative infection related events was compared in both groups. The demographic and treatment-related characteristics of both groups were similar. Peroperative urine samples revealed bacteriuria in one and two patients for the first and second groups, respectively. Fever of >38°C (P=0.52) developed in four (11.1%) patients in the first and six (16.2%) patients in the second group. Positive stone cultures developed in eight patients; of those, three (8.3%) were in the first and five (13.5%) were in the second group (P=0.47). The urine sent for culture on the nephrostomy catheter withdrawal day had positive results in three and two patients for the first and second groups (P=0.54). Both antibiotic prophylaxis methods were similar in terms of preventing septic complications. Therefore, we think that a single-dose antibiotic prophylaxis protocol may be safely recommended to patients undergoing PCNL.

Cefditoren: Comparative efficacy with other antimicrobials and risk factors for resistance in clinical isolates causing UTIs in outpatients.

BackgroundTo investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients.MethodsDuring a multicenter survey of Enterobacteriaceae causing UTIs in outpatients during 2005–2007, Cefditoren MICs were determined by agar dilution method in a randomly selected sample of uropathogens. Susceptibility against 18 other oral/parenteral antimicrobials was determined according to Clinical and Laboratory Standards Institute methodology.ResultsA total of 563 isolates (330 Escherichia coli, 142 Proteus mirabilis and 91 Klebsiella spp) was studied; MIC50/MIC90 of Cefditoren was 0.25/0.5 mg/L respectively, with 97.1% of the isolates being inhibited at 1 mg/L. All 12 strains producing ESBLs or AmpC enzymes were resistant to cefditoren. Susceptibility rates (%) for amoxicillin/clavulanic acid, cefuroxime axetil, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole and fosfomycin were 93.1- 94.1- 96.8-93.1-71.9 and 92.8% respectively. Cefditoren MIC was significantly higher in nalidixic/ciprofloxacin non-susceptible strains; resistance to cefditoren was not associated with resistance to mecillinam, fosfomycin nitrofurantoin and aminoglycosides. Multivariate analysis demonstrated history of urinary infection in the last two weeks or three months as risk factors for cefditoren resistance.ConclusionsCefditoren exhibited enhanced in vitro activity against the most common uropathogens in the outpatient setting, representing an alternative oral treatment option in patients with risk factors for resistance to first-line antibiotics.

A case of bilateral suppurative arthritis of hip joint with concomitant pyomyositis.

A case of bilateral suppurative arthritis of hip joint with concomitant pyomyositis.

Genome Sequencing of a Neisseria gonorrhoeae Isolate of a Successful International Clone with Decreased Susceptibility and Resistance to Extended-Spectrum Cephalosporins

The recent emergence of Neisseria gonorrhoeae strains with decreased susceptibility to extended-spectrum cephalosporins is a major concern globally. We sequenced the genome of an N. gonorrhoeae multiantigen sequence typing (NG-MAST) ST1407 isolate (SM-3) with decreased susceptibility and resistance to oral extended-spectrum cephalosporins. The isolate was cultured in 2008 in San Francisco, CA, and possessed mosaic penA allele XXXIV, which is associated with an international clone that possesses decreased susceptibility as well as resistance to oral extended-spectrum cephalosporins globally. The genome sequence of strain NCCP11945 was used as a scaffold, and our assembly resulted in 91 contigs covering 2,029,064 bp (91%; >150× coverage) of the genome. Numerous instances of suspected horizontal genetic transfer events with other Neisseria species were identified, and two genes, opa and txf, acquired from nongonococcal Neisseria species, were identified. Strains possessing mosaic penA alleles (n = 108) and nonmosaic penA alleles (n = 169) from the United States and Europe (15 countries), cultured in 2002 to 2009, were screened for the presence of these genes. The opa gene was detected in most (82%) penA mosaic-containing isolates (mainly from 2007 to 2009) but not in any penA nonmosaic isolates. The txf gene was found in all strains containing opa but also in several (18%) penA nonmosaic strains. Using opa and txf as genetic markers, we identified a strain that possesses mosaic penA allele XXXIV, but the majority of its genome is not genetically related to strain SM-3. This implies that penA mosaic allele XXXIV was transferred horizontally. Such isolates also possessed decreased susceptibility and resistance to oral extended-spectrum cephalosporins. These findings support that genetic screening for particular penA mosaic alleles can be a valuable method for tracking strains with decreased susceptibility as well as resistance to oral extended-spectrum cephalosporins worldwide and that screening using only NG-MAST may not be sufficient.

AN EFFICIENT HPLC-UV METHOD FOR THE QUANTITATIVE DETERMINATION OF CEFADROXIL IN HUMAN PLASMA AND ITS APPLICATION IN PHARMACOKINETIC STUDIES

Cefadroxil is a semi-synthetic first-generation oral cephalosporin used in the treatment of mild to moderate infections of the respiratory and urinary tracts, skin and soft tissue infections. In this work a simple, rapid, economic and sensitive HPLC-UV method is described for the quantitative determination of cefadroxil in human plasma samples using lamivudine as internal standard. Sample pre-treatment was accomplished through protein precipitation with acetonitrile and chromatographic separation was performed with a mobile phase consisting of a mixture of sodium dihydrogen phosphate monohydrate solution, methanol and acetonitrile in the ratio of 90:8:2 (v/v/v) at a flow rate of 1.0 mL/min. The proposed method is linear between 0.4 to 40.0 µg/mL and its average recovery is 102.21% for cefadroxil and 97.94% for lamivudine. The method is simple, sensitive, reproducible, less time consuming for determination of cefadroxil in human plasma. The method can therefore be recommended for pharmacokinetics studies, including bioavailability and bioequivalence studies.

Using the Neisseria gonorrhoeae Multiantigen Sequence-Typing Method to Assess Strain Diversity and Antibiotic Resistance in San Francisco, California

Urogenital Neisseria gonorrhoeae isolates (266) collected in San Francisco, CA, in 2009 were analyzed for antimicrobial susceptibility and were subsequently genotyped by N. gonorrhoeae multiantigen sequence typing (NG-MAST). Isolates of identical or closely related sequence types were found to possess highly similar phenotypes with regard to drug susceptibility. Isolates containing decreased susceptibility to oral cephalosporins were detected in 2009 and were found to contain the mosaic penA allele (XXXIV) found previously to be associated with decreased susceptibility to cephalosporins. A better understanding of the relationships between phenotypic and genotypic markers for antimicrobial resistance may be helpful to the development of effective surveillance systems for drug-resistant N. gonorrhoeae.

P52 New treatment guideline of Neisseria gonorrhoeae and test of cure: how feasible is it?

BackgroundTreatment failure with oral cephalosporins in gonorrhoea caused by multidrug resistance has been reported. The national guidelines were updated in 2011 due to reduced sensitivity to antimicrobials. Test of cure...

In Vitro Interaction between Cefixime and Amoxicillin-Clavulanate against Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli Causing Urinary Tract Infection

We read with interest the article by Campbell et al. ([4][1]) suggesting that the combination of clavulanate and oral expanded-spectrum cephalosporins (OESCs) could be an interesting therapeutic option for urinary tract infection (UTI) due to Escherichia coli producing extended-spectrum beta-

Detection of fluoroquinolone‐induced tendon disorders using a hospital database in Japan

Tendinitis and tendon rupture are well-known side effects of fluoroquinolones (FQs) in Western countries. In Japan, some case reports have been reported; however, the incidence of FQ-induced tendon disorders has not been investigated. The aims of this study were to measure the occurrence of tendon disorders associated with FQs in Japanese patients and to compare the observed risk with that of previous reports. Moreover, the observed risk in FQ-prescribed patients was compared with that in cephalosporin-prescribed patients. The Hamamatsu University Hospital database was examined to determine the risk of tendon disorders that occurred in all inpatients and outpatients between the first day of prescription of an oral FQ or cephalosporins to the calculated end date plus 30 days. The risk of tendon disorders, the risk ratio, and their 95% confidence intervals (CIs) were evaluated. From April 1996 to December 2009, FQs were prescribed to 17 147 patients, 14 of whom had tendon disorders (risk: 0.082%, 95%CI: 0.049-0.137). The risk of a tendon disorder in FQ-prescribed patients was significantly higher than that in cephalosporin-prescribed patients (five tendon disorders in 38 517 patients, risk: 0.013%, 95%CI: 0.006-0.030, and p < 0.001). The risk ratio of a tendon disorder in FQ-prescribed patients in relation to cephalosporin-prescribed patients was 6.29 (95%CI: 2.27-17.46). A large discrepancy in the risk of tendon disorders was not observed between our findings and previous reports. A hospital database search revealed that the risk of tendon disorders in Japanese patients administered with FQs was higher than in those administered with cephalosporins.

Fluoroquinolone Resistance in Neisseria gonorrhoeae: Fitness Cost or Benefit?

The successful treatment of gonorrhea, presently the second most prevalent bacterial sexually transmitted infection worldwide, has historically taken full advantage of the introduction of successive new categories of antimicrobial agents to successfully eliminate the microorganism causing this disease, Neisseria gonorrhoeae. New antibiotics have replaced older ones for treatment because N. gonorrhoeae has progressively developed resistance to each class introduced; first to sulphonamides, then to penicillins, tetracyclines, and then quinolones and macrolides [1, 2]. While the last class of antimicrobial effective for the treatment of gonorrhea is the third-generation cephalosporins, more and more reports are emerging of in vitro decreased susceptibility and treatment failures to the oral cephalosporins, such as cefixime, coupled with recent reports of strains with highlevel resistance to ceftriaxone [3–5]. The strains with high-level resistance to cephalosporins also exhibited resistance or reduced susceptibility to several other antibiotics. Thus, there is a great concern that gonorrhea has become an untreatable superbug in certain instances, and the search for effective alternative treatment strategies and therapies, possibly a combination of antibiotics, is urgent [5, 6]. The emergence of resistance to some classes of antimicrobial has been so rapid and sustained that a basic understanding of the factors underscoring the ability of N. gonorrhoeae isolates to survive in potentially lethal antimicrobial environments, a measure of fitness, is lacking. The report by Kunz et al in this issue of the Journal of Infectious Diseases describes fluoroquinolone resistance in N. gonorrhoeae as it relates to microbial fitness. Fluoroquinolones were introduced for the treatment of gonorrhea infections in the late 1980s following the rise and worldwide dissemination of both plasmid-mediated and chromosomal resistance to penicillins and tetracyclines [1, 2]. However, the introduction of fluoroquinolones, such as ciprofloxacin, for treatment was quickly followed by reports of resistance, first in Asia and subsequently worldwide [7, 8]. Once resistance to fluoroquinolones reached 5% of the N. gonorrhoeae isolates tested in any region, the accepted cutoff where it is recommended that treatment be changed, the third-generation cephalosporins were then recommended as the primary antibiotics to treat gonorrhea infections [9, 10]. Interestingly, some countries reported almost 100% resistance of N. gonorrhoeae isolates to fluoroquinolones [11], and this high percentage of resistance has not diminished appreciably. In other countries, despite some diminution of total percentages of resistant isolates, fluoroquinolone resistance persists at levels higher than 5% despite the withdrawal of these antimicrobials for the treatment of gonorrhea [11, 12]. The withdrawal of antibiotics can result in some modest diminution of resistance levels, possibly because antibiotic resistant isolates may have less survival advantage, or be less fit, than susceptible isolates [13]. However, given the maintenance of high percentages of ciprofloxacin resistant N. gonorrhoeae, it seems that, in some circumstances, antibioticresistant N. gonorrhoeae isolates may have a fitness advantage and not a fitness deficit. Bacterial fitness has been broadly described as the ability of a particular strain to survive and reproduce [13]. Fitness, often measured by growth rate and generation time, is frequently adversely affected by the development of antibiotic resistance. Most models used for bacterial fitness analysis involve in vitro and in vivo competition assays [13], and a mathematical model with high predictive value that associates fitness costs with drug-resistant bacteria has been reported [14]. Overall, the challenge in measuring bacterial fitness in antimicrobial environments is to choose a set of assays in the context of different bacterial environmental niches, genetic Received 5 September 2011; accepted 16 December 2011; electronically published 5 April 2012. Correspondence: Jo-Anne R Dillon, PhD, Professor, Dept of Biology, and Research Scientist, Vaccine and Infectious Disease Organization, University of Saskatchewan, 120 Veterinary Rd, Saskatoon, Saskatchewan, Canada S7N-5E3 ( j.dillon@usask.ca). The Journal of Infectious Diseases 2012;205:1775–7 © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. DOI: 10.1093/infdis/jis281

Surveillance of gonococcal antimicrobial susceptibility resulting in early detection of emerging resistance

To undertake laboratory and clinical surveillance of gonococcal antimicrobial susceptibility to various therapeutic agents in Hong Kong, so as to monitor for emerging resistance and to inform on appropriate choice of empirical therapy. Trends in susceptibility of gonococci to ceftriaxone, spectinomycin, ceftibuten and azithromycin were monitored over time. Isolates with reduced susceptibility to oral extended-spectrum cephalosporins were further characterized by detection of the mosaic penA gene and typing by Neisseria gonorrhoeae multi-antigen sequence typing (NG-MAST). Correlation with clinical and epidemiological findings was undertaken on isolates positive for the mosaic penA gene. Trends in susceptibility of gonococci to ceftriaxone, spectinomycin and ceftibuten remained stable between 2005 and 2010. In 2010, 30.3% of tested strains were not susceptible to azithromycin. The percentage of gonococcal strains harbouring the mosaic penA gene increased from 1.0% during April to December 2010 to 8.2% during January to September 2011 (P < 0.0001). Review of available clinical records showed that, out of 35 patients infected by strains positive for the mosaic penA gene, 30 had laboratory-documented treatment failure. This study showed that ceftriaxone and spectinomycin remained effective against gonorrhoea in Hong Kong. There was an alarming increase in strains with reduced susceptibility to oral extended-spectrum cephalosporins associated with clinical treatment failure. One-third of gonococcal isolates were non-susceptible to azithromycin. The need to switch to agents other than oral extended-spectrum cephalosporins for empirical treatment is imminent. Continued surveillance with strain characterization is essential to monitor the effectiveness of currently recommended therapy.

Increasing antibiotic resistance among uropathogens isolated during years 2006-2009: impact on the empirical management

Urinary tract infections (UTI) are one of the most common infections with an increasing resistance to antimicrobial agents. Empirical initial antibiotic treatment of UTI must rely on susceptible data from local studies. Retrospective analysis of isolated bacteria from children with UTIs was performed at the university hospital during years 2006-2009. The findings were compared with data collected in a similar study carried out in 2002-2003. A total of 1439 uropathogens were isolated. Escherichia coli (E.coli) was the leading cause, followed by Enterobacter, and other gram negative bacilli. It was observed resistance of E.coli to ceftriaxone, cefexime, amikacin, gentamycin, and nalidixic acid; Enterobacter to cefexime; and the resistance of gram negative bacilli to gentamicin and cefexime increased significantly. The highest effective antibiotic was Imipenem, ciprofloxacin, and amikacin with 96.7%, 95% and 91% sensitivity rates, respectively, followed by ceftriaxone 77.2%, gentamicin 77%, nitrofurantoin 76.4%, nalidixic acid 74.3% and cefexime with 70%. The use of nitrofurantoin or nalidixic acid as initial empirical antibacterial therapy for cystitis seems appropriate. For cases of simple febrile UTI, the use of initial parenteral therapies with amikacin or ceftriaxone followed by an oral third generation cephalosporin also seemed appropriated, and in cases of severely ill patients or complicated UTI, imipenem as monotherapy or, a combination of Ceftriaxone with an aminoglycoside, are recommended.

Quiz: Sternoclavicular Joint Swelling in a Previously Healthy Adult

A 77-year-old woman was admitted to our department because of 30-day history of low grade fever (up to 38.5°C) and pain in the left sternoclavicular joint. Twenty days before admission a progressively worsening swelling of the area occurred. She did not report any trauma and apart from low grade fever, the patient had also general symptoms such as loss of appetite, weakness and malaise. Her past medical history revealed only mild arterial hypertension. The patient had never received any kind of immunosuppression in the past whereas, there was no history of tuberculosis, diabetes mellitus, iv drug abuse, immune dysfunction or other known risk factors which have been associated with the presence of sternoclavicular joint infection (SCJI) [1]. She had been treated previously by her own general practitioner for 10 days before admission with oral beta-lactam antibiotic and cephalosporin without any improvement. On admission, physical examination revealed a dolorous, inflammatory lesion of the left sternoclavicular joint (Figure 1) and movement limitation of the left arm, whereas there was no ascites or peripheral lymphadenopathy. Laboratory work-up showed only moderate elevation of CRP (5.7 mg/dL; upper normal limit < 1 mg/dL), increased erythrocyte sedimentation rate (ESR; 66 mm/1h), positive tuberculin test (20 mm) while chest x-ray was normal. MRI of the area showed mild osteomyelitis of the clavicle and cellulitis of the surrounding tissues with no effusion at SCJ. The CT scans of the thorax, upper and lower abdomen and retroperitoneal space revealed no lymphadenopathy or pulmonary lesions. After drawing several sets of blood cultures, treatment with daptomycin was started at a dose of 8 mg/kg/day. We chose daptomycin as unfortunately in our area the rates of communityand hospital-associated methicillin resistant Staphylococcus aureus (MRSA) infections have been increased from 14.5% in 2000 up to 40-50% in 2006 and 65% in 2007-2009 [2,3]. Therefore, in our practice we usually manage severe infections of soft tissues, bone or spine initially with vancomycin, teicoplanin or daptomycin until a positive culture with sensitivity tests was obtained [4].

Detection of multidrug-resistant gonorrhoea in the Gauteng province

Two cefpodoxime-resistant Neisseria gonorrhoeae isolates were identifed with high minimum inhibitory concentrations (MIC) for oral cephalosporins. The ceftriaxone MICs for both isolates were still in the susceptible range, although raised at 0.064 mg/l. Both isolates were cultured from urethral specimens that were collected from male patients who had presented to their general practitioners with urethral discharge. Patient 1 was treated empirically with azithromycin. Patient 2, who reported having had sex with other men, was given intravenous ceftriaxone as he had recently failed two courses of oral cefxime. Both isolates were also highly resistant to ciprofoxacin, resistant to penicillin (s-lactamase negative) and resistant to tetracycline (and thus doxycycline), and exhibited decreased susceptibility to both azithromycin and gentamicin. On molecular testing, both isolates were found to have mosaic penA genes, which encode for penicillin-binding protein 2. Mosaic penA gene formation is the most common ge...

Detection of Favorable Oral Cephalosporin-Clavulanate Interactions by In Vitro Disk Approximation Susceptibility Testing of Extended-Spectrum-Beta-Lactamase-Producing Members of the Enterobacteriaceae

Extended-spectrum-beta-lactamase (ESBL)-producing members of the Enterobacteriaceae are often resistant to multiple drug classes, making therapy of urinary infections with oral antibiotics difficult. Previously it was shown that amoxicillin-clavulanate can provide clavulanate inhibition of ESBLs and protect an oral cephalosporin present in combination when tested by broth microdilution. This study has shown that disk approximation testing could detect favorable cephalosporin-clavulanate interactions among a group of 101 previously characterized members of the Enterobacteriaceae with CTX-M, SHV, or TEM ESBLs.

Cephalosporins for Patients with a History of Penicillin Allergy: The Safety of an Oral Test Dose

Background Cephalosporins are often avoided in patients labeled with penicillin allergy due to potential cross-reaction. We describe the utility of an oral cephalosporin test dose in patients with penicillin allergy. Method A retrospective review of all inpatients labeled with penicillin allergy who received a single oral cephalosporin dose, identified through the pharmacy records between April 1, 2004 and October 30, 2008. Results Ninety-seven inpatients met our selection criteria. Type of penicillin reaction was described as rash/hives/pruritis, anaphylaxis, angioedema, and unknown in 53 (54.7%), 10 (10.3%), 7 (7.2%), and 27 (27.8%) cases, respectively. The test dose used was cephalexin 250 mg (56.7%) or 125 mg (35.1%) and cefuroxime axetil 125 mg (8.2%). Reaction to the test dose was noted in 5 (5.2%) patients, including rash (n=2), breathing difficulty (n=2), and asymptomatic eosinophilia (n=1). Breathing difficulty resolved with diphenhydramine/corticosteroids in one case and without any therapy in the other. Cephalosporin therapy was initiated within 3 hours (interquartile range, 2-6 hours) after test dose in 90/93 patients without test-dose reaction. Two (2.2 %) patients developed reaction during treatment: rash (n=1) and angioedema (n=1). One case complained of anxiety, and therapy was interrupted. Test-dose and treatment reactions were transient and easily managed. Conclusions An oral cephalosporin test dose was safe in patients labeled with penicillin allergy and predicted subsequent cephalosporin tolerance in nearly 90% of patients.

Antimicrobial susceptibility of Escherichia coli from community-acquired urinary tract infections in Europe: the ECO·SENS study revisited

This study determined the antimicrobial susceptibility of Escherichia coli causing community-acquired, acute, uncomplicated, non-recurrent urinary tract infection in unselected women aged 18–65 years and compared the results with those obtained 8 years earlier in the first ECO·SENS study (1999–2000). During 2007–2008, urine samples were taken from 1697 women in Austria, Greece, Portugal, Sweden and the UK. The countries were chosen to represent areas of Europe indicated to have more (Greece and Portugal) or less (UK, Austria and Sweden) problems with resistance. Antimicrobial susceptibility testing of 903 E. coli isolates (150–200 isolates per country) to 14 antimicrobials was performed by disk diffusion using European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. In E. coli, resistance to mecillinam, cefadroxil (representing oral cephalosporins), nitrofurantoin, fosfomycin trometamol, gentamicin and the third-generation cephalosporins cefotaxime and ceftazidime was <2%, with the following exceptions: gentamicin in Portugal (2.8%); fosfomycin in Greece (2.9%); and cephalosporins in Austria (2.7–4.1%). Resistance levels were higher for amoxicillin/clavulanic acid (2.0–8.9%) and ciprofloxacin (0.5–7.6%) and much higher to ampicillin (21.2–34.0%), sulfamethoxazole (21.2–31.3%), trimethoprim (14.9–19.1%) and trimethoprim/sulfamethoxazole (14.4–18.2%). Resistance to quinolones and trimethoprim increased between the ECO·SENS I (1999–2000) and ECO·SENS II (2007–2008): nalidixic acid 4.3% to 10.2%; ciprofloxacin 1.1% to 3.9%; and trimethoprim 13.3% to 16.7%. In the previous study, no isolates with extended-spectrum β-lactamase were found; however, in the present study 11 isolates were identified as having either CTX-M or AmpC.

Antimicrobial therapy of urinary tract infections in children

The main objectives in childhood urinary tract infections are rapid recovery from complaints, prevention of urosepsis and infection-related complications as well as the prevention of renal parenchymal damage. Calculated antibiotic therapy should take the local resistance rates of uropathogens into consideration. The current situation of bacterial resistances differs from region to region. In Escherichia coli, resistance rates against cephalosporins, aminoglycosides, nitrofurantoin und chinolones have been relatively low. In contrast, resistance rates against ampicillin have increased over the last 20 years. A similar trend has been observed for TMP/SMX. The choice of appropriate antibiotics, the duration of therapy and the form of application depend on age, severity of clinical symptoms and the presence of complicating factors. In early infancy, a combination of aminoglycoside/ampicillin or ceftazidime/ampicillin is commonly recommended as first-line treatment in pyelonephritis. Pyelonephritis in young infants should always be treated in a paediatric clinic. In later infancy and childhood, an oral third-generation cephalosporin can be used.

Antibiotic Prophylaxis After Uncomplicated Ureteroscopic Stone Treatment: Is There a Difference?

We evaluated the risk of development of a symptomatic urinary tract infection (UTI) based on the antibiotic prophylaxis given to a patient during and after uncomplicated ureteroscopy (URS) for urolithiasis. We retrospectively reviewed the charts of patients who underwent URS, laser lithotripsy, and stent placement for the management of stones from 2004/2005 (group 1) and 2009/2010 (group 2). We excluded all patients with preoperative positive cultures, preoperative antibiotics, urinary diversion, who underwent concomitant percutaneous nephrolithotomy, or had strings attached to the stents. All patients received a first-generation intravenous cephalosporin or fluoroquinolone at the time of initial intervention and had ureteral stents placed intraoperatively. Group 1 received an oral fluoroquinolone for 1 week postoperatively. Group 2 received an oral first-generation cephalosporin antibiotic peri-stent removal only. Antibiotics were appropriately changed according to the local resistance patterns. All stents were removed within 5 to 7 days. Our primary end point was symptomatic UTI. After the exclusion criteria, group 1 had 48 patients, group 2 had 49. There was no statistical difference in the incidence of symptomatic UTI between the two groups; each group had one UTI (2% risk) (P=0.988). There were no cases of readmission, pyelonephritis, UTI, surgical reintervention, or Clostridium difficile. The UTI in group 1 was secondary to Escherichia coli and in group 2, Staphylococcus species; both were managed with oral antibiotics. The use of oral peri-stent removal antibiotic prophylaxis is sufficient to prevent symptomatic UTIs in patients who have undergone uncomplicated URS for urolithiasis. The judicious use of antibiotics in uncomplicated cases may help lower the incidence of resistant organisms and other complications related to the widespread use of antibiotics.