Pediatric Urinary Tract Research Articles

Paediatric Urinary Tract Infection: Microbiologic Profile and Antibiotics Sensitivity in Children Presenting with UTI

Background: This study was designed to determine the microbiologic profile and Antibiotics Sensitivity in Children presenting with UTI. Materials & Methods: This hospital based prospective study was conducted in 28 patients Patients from 2 months to 12 years were admitted to the pediatric ward and visited in outpatient department (OPD) with diagnosis of UTI based on history with routine and microscopic examination of urine were considered for this study. The UTI investigation protocol recommended ultrasound, voiding cystourethrography (VCUG), and DMSA scan. Clinical and laboratory parameters at the index infection, including highest measured temperature, highest C-reactive protein (CRP), bacterial findings, and the number of febrile recurrences, were recorded. Results: Fever was the most common symptom accounting for 76.4% of patients with nausea and vomiting (42.8%), dysuria (53.6%), abdominal pain (57.1%) and anorexia (46.4%). Urine analysis was done in all suspected cases of UTI. Among all urine samples 60.7% had WBC >10/hpf, followed by 87 (28.6%) which had WBC between 6-10/hpf. Only 6 (10.7%) had WBC 5 or less. Among all urine analyses 68 (57.1%) Conclusion: E. coli (82%) was the most common organism found followed by Klebsiella pneumonia (12%), Proteus mirabilis (5%)and 1% were other pathogens like Enterococcus species (Table 4, Fig 1). All isolated E. coli was sensitive to Imipenem, Nalidixic acid, Netilmicin and Vancomycin. E. coli were 80-90% sensitive to Amikacin, Ceftriaxone, Cefuroxime, Ofloxacin, Gentamicin and Nitrofurantoin.

RETRACTED ARTICLE: Antimicrobial misuse in pediatric urinary tract infections: recurrences and renal scarring

BackgroundIn children, urinary tract infection (UTI) is one of a common bacterial infection. This study was conducted to detect the uropathogen, antimicrobial susceptibility, pathogen associated with recurrences and renal scarring in children initially taken care from general practitioners and later presented to tertiary care.MethodsEvery inward UTI episode, culture and antimicrobial susceptibility was done while on past 6-month, history of infections and use of antimicrobials was collected using clinical records and demonstration of antimicrobials. Children with recurrent pyelonephritis was followed and in vitro bio film formation was assessed.ResultsFrequency of UTI was significantly high among infants (p = 0.03). Last 6-month, all (220) were exposed to antimicrobials. Cefixime was the commonly prescribed antimicrobial (p = 0.02). In current UTI episode, 64.5% (142/220) of children with UTI were consulted GPs’ prior to seek treatment from tertiary care pediatric unit (p = 0.02). While on follow up child who developed UTI, found urine culture isolates were significantly shifted from E. coli and K. pneumoniae to extended spectrum of beta-lactamase (ESBL) E. coli and K. pneumoniae. Out of 208 participants, 36 of them had re-current pyelonephritis (R-PN). Renal scarring (RS) was detected in 22 out of 70 patients with pyelonephritis following dimercaptosuccinic acid scan. Following each episodes of recurrent pyelonephritis 11% of new scar formation was detected (p = 0.02). Bio film forming E. coli and K. pneumoniae was significantly associated in patients with R-PN (p = 0.04).DiscussionMedical care providers often prescribe antimicrobials without having an etiological diagnosis. While continuing exposure of third generation cephalosporin and carbapenem leads to development of ESBL and CRE microbes in great. The empiric uses of antimicrobials need to be stream lined with local epidemiology and antimicrobial susceptibility pattern. R-PN in childhood leads to RS. In great, bio film formation act as the focus for such recurrences.

Management of Urinary Tract Infections in Young Children: Balancing Admission With the Risk of Emergency Department Revisits

ObjectiveOral antibiotics effectively treat most pediatric urinary tract infections (UTIs); however, children with UTIs are frequently admitted. We examined variation and trends in admission for children with UTIs plus investigated the relationship between admission and emergency department (ED) revisits for those initially managed on an outpatient basis. We hypothesized that hospitals would have similar 3-day revisit rates regardless of the admission rate at the index visit. MethodsThis was a retrospective analysis of 36 hospitals in the Pediatric Health Information System. ED visits for children aged <2 years presenting with UTI between 2010 and 2016 were studied. Main outcomes were age-stratified and included admission and 3-day ED revisit rates. Regression analyses were used to test hospital-level associations between outcomes and linear temporal trends. ResultsA total of 41,792 visits were studied. The overall admission rate was 27%. The admission rate was 89% for children aged <2 months and 15% for those aged 2 to 24 months. Interhospital admission rates varied from 6% to 64%. Admission and revisit rates were inversely related (mean change, –0.07; 95% confidence interval [CI], –0.13 to –0.02 per 1% increase in admission rate); however, lower admission rates were not associated with increased revisits leading to admission (mean change, –0.02; 95% CI, –0.07 to 0.03). Over the study period, admission rates were stable (test for linear trend: adjusted odds ratio [aOR], 0.99; 95% CI, 0.95–1.02); however, among infants aged <2 months, admissions decreased (aOR, 0.92; 95% CI, 0.88–0.97). ConclusionsA substantial variation in admission rates exists for children with UTI. Although hospitals with lower admission rates had higher revisit rates, those hospitals did not have an increase in revisits with subsequent admission, supporting the goal of outpatient management.

Supplementary data: A critical review of recent clinical practice guidelines for pediatric urinary tract infection

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The Role of Non-invasive Testing in Evaluation and Diagnosis of Pediatric Lower Urinary Tract Dysfunction.

The symptoms of lower urinary tract dysfunction (LUTD) including urinary incontinence, frequency, and urgency are among the most common reasons children are referred to pediatric urologists. Despite this, the workup for LUTD is often time consuming and a source of frustration for patients, parents, and clinicians alike. In the current review, we summarize the important role non-invasive testing plays in the diagnosis and management of children with LUTD and to show how use of these tests can help avoid the need for more invasive testing in the majority of children. Non-invasive tests such urine studies, uroflowmetry ± simultaneous electromyography, assessment of post-void residual, renal/bladder ultrasound, and pelvic ultrasound when used appropriately can provide valuable information to facilitate decision making during the evaluation of children with LUTD. While these tests should be employed prior to more invasive testing such as urodynamic studies, they can often act as a surrogate for the more invasive tests. Non-invasive tests can help us in our goal of improving diagnostic ability to better classify the child's LUTD into an actual condition which allows targeted treatment in the hope of better outcomes and more satisfied patients and families.

Etiology and antimicrobial resistance patterns in pediatric urinary tract infection.

Urinary tract infection (UTI) is one of most common pediatric infections. The aim of this study was to investigate the etiology and antimicrobial resistance patterns in children hospitalized at Children's Hospital of Nanjing Medical University. We conducted a retrospective, descriptive study of all UTI from 1 January 2013 to 30 November 2016 in children discharged from Nanjing Children's Hospital. The isolated pathogens and their resistance patterns were examined using midstream urine culture. A total of 2,316 children with UTI were included in the study. The occurrence rates of isolated pathogens were as follows: Enterococcus spp., 35.15%; Escherichia coli, 22.32%; Staphylococcus aureus spp., 7.73%; Streptococcus spp., 7.51%; and Klebsiella spp., 6.95%. Uropathogens had a low susceptibility to linezolid (3.47%), vancomycin (0.92%), imipenem (5.74%), and amikacin (3.17%), but they had a high susceptibility to erythromycin (90.52%), penicillin G (74.01%), cefotaxime (71.41%), cefazolin (73.41%), cefuroxime (72.52%), and aztreonam (70.11%). There is high antibiotic resistance in hospitalized children with UTI. Susceptibility testing should be carried out on all clinical isolates, and the empirical antibiotic treatment should be altered accordingly.

Risk factors for repeat surgical intervention in pediatric nephrolithiasis: A Pediatric Health Information System database study

Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset. Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors. A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age <5 years were independent risk factors for retreatment. Use of ureteral stenting, most commonly employed in URS, was also a strong predictor of retreatment. Odds for reintervention, adjusted by multivariate modeling, are shown in the Figure. Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC.

Pediatric urinary tract infection as a cause of outpatient clinic visits in southern Ethiopia: a cross sectional study

Failure to timely diagnose and treat urinary tract infections is associated with grave long term consequences. The objectives of this study included assessing the proportion and predictors of Urinary Tract Infection (UTI) as a cause of pediatric outpatient department (OPD) visits and determining common uropathogens with antimicrobial susceptibility pattern. A cross sectional study was conducted from May to September 2015 among children of less than 15 years old at a tertiary center in Hawassa, Ethiopia. Children who fulfilled predefined eligibility criteria were recruited to undergo urine culture and urine analysis. A total of 863 children visited the OPD during the study period among which 269(31.2%) fulfilled the predefined eligibility criteria. Urine culture was positive for 74/269(27.5%) of the clinically suspected children. Male uncircumcision (adjusted odds ratio (aOR) 3.70; 95% CI 1.34-10.16) and under nutrition (aOR 5.41; 95%CI 2.64-11.07) were independent predictors of culture positivity. More than 5 WBC per high power field (aOR 4.7, 95% CI 1.8-12.7) on microscopy, urine PH > 5.0 (aOR 2.6, 95%CI 1.2-5.8), and positive leukocyte esterase (aOR 9.9, 95%CI 4.1-25.7) independently predicted positive growth on urine culture. Escherichia coli (34/74, 45.9%) and Klebsiella spp (18/74, 24.3%) were the most frequent isolates. High resistance was noted against amoxicillin (70.6%) and cotrimoxazole (97.1%) by E. coli. UTI accounted for a tenth of total OPD visits. Commonly used first line antibiotics showed high level resistance to common etiologies of UTI. UTI should be suspected in febrile children, and antibiograms should be done to tailor prescription of antibiotics.

Update on Pediatric Kidney and Urinary Tract Imaging

Purpose This paper will review the current roles of imaging for assessing the pediatric kidneys and urinary tract, while emphasizing recent trends and advances in imaging techniques.

Bacterial isolates and their antimicrobial susceptibility patterns among pediatric patients with urinary tract infections.

Urinary tract infection is a common pediatric problem with the potential to produce long-term morbidity. Therefore, appropriate diagnosis and prompt treatment is required. However, studies about magnitude of uropathogenicity and antimicrobial resistance pattern of pediatric urinary tract infection (UTI) are lacking in resource limited countries including Ethiopia. This study was aimed to determine bacterial isolates, antimicrobial susceptibility pattern among pediatric patients with UTI. A cross- sectional study was conducted. Pathogenic bacterial isolates were identified by culture and biochemical methods following standard procedures. Antimicrobial susceptibility testing of the isolates for commonly used antibiotics was done using the standard disc diffusion method on Muller Hinton agar. Associations between dependent and independent variables were measured using chi-square test and within 95% confidence interval. P values <0.05 were considered as statistically significant. A total of 310 pediatric patients were included in the study, and 82 (26.45%) bacterial isolates were detected. Gram- negative bacteria were predominant etiologic agents of UTI in this study. E. coli was the most frequently occurring pathogen (n=45; 54.88%) followed by S. aureus and P.aeruginosa (n=8; 9.75% for both), P. vulgaris, P.aeruginosa (n=4; 4.88%, for both) and Enterococcus species (n=3; 3.66%). All K. pneumoniae, P. mirabilis, and K. ozanae straines were 100% resistance to ampicillin, followed by P. aeruginosa (87.5%) and E. coli (69%). While all Gram- positive bacterial isolates were 100% sensitive to ciprofloxacin. Malnutrition, history of catherization and previous history of UTI were independently associated with UTI (p=0.000). There was a high prevalence of uropathogenic bacteria and drug resistance particularly to ampicillin (72%) and tetracycline (37.80%). This condition indicates that antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than empirical treatment.

Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction

To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.

Management of pediatric lower urinary tract stones in Saiful Anwar hospital Malang, Indonesia

The aim of this study was to describe and analyze the characteristics of pediatric lower urinary tract stones in Saiful Anwar Hospital Malang. Data for 114 pediatric urolithiasis patients treated between January 2004 and December 2015 were retrospectively collected; 71.1% of cases involved pediatric lower urinary tract stones, which were specified into 68.4% bladder stones and 2.6% urethral stones. The data were then described and analyzed based on demographic characteristics, body mass index (BMI), stone diameter, management, length of hospitalization and stone analysis results. Pediatric stones accounted for 2.2% of all stone disease in Saiful Anwar Hospital (incidence 1.1 per 1000 pediatric cases/year). Males were predominant in every age group except in the first 5 years of life. Most patients had sought medical attention due to uncomfortable voiding (39.5%). Mean BMI was 18.7 ± 3.5 kg/m². Mean stone size was 29 ± 22 mm. Most bladder stones were treated by open vesicolithotomy (70.4%) instead of percutaneous vesicolithotripsy (25.9%). Urethral stones were treated by posterior lubrication, and treatment was continued by percutaneous vesicolithotripsy in two patients/2.5% (one patient/1.2% by anterior lubrication). Length of hospitalization for open vesicolithotomy was 8 ± 3 days, which was significantly longer than that for percutaneous vesicolithotripsy (5 ± 2.3 days). Three (13%) vesicolithotripsy patients needed secondary treatment (vesicolithotomy). The most common stone constituent was calcium oxalate (35.8%). Pediatric lower urinary tract stones in Saiful Anwar Hospital were reported predominantly in males, with a peak rate in early and middle childhood. Percutaneous vesicolithotripsy offers a shorter hospital stay than open vesicolithotomy.

Clinical profile and antibiotic sensitivity pattern in pediatric urinary tract infection of a tertiary care hospital in Bhubaneswar, Odisha

Clinical profile and antibiotic sensitivity pattern in pediatric urinary tract infection of a tertiary care hospital in Bhubaneswar, Odisha

A critical review of recent clinical practice guidelines for pediatric urinary tract infection.

Concerns regarding the quality, credibility, and applicability of recently published pediatric urinary tract infection (UTI) clinical practice guidelines have been raised due to the inconsistencies of recommendations between them. We aimed to determine the quality of the recent clinical practice guidelines on pediatric UTI by using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument, and summarize the standard of care in diagnosis and management of pediatric UTI from the top three clinical practice guidelines. A systematic literature search was performed on medical literature electronic databases and international guideline repository websites. English language-based clinical practice guidelines from 2007-2016 endorsed by any international society or government organization providing recommendations for the management of pediatric UTI were considered. Eligible clinical practice guidelines were independently appraised by six reviewers using the AGREE II tool. Clinical practice guidelines were assessed for standardized domains and summarized for overall quality. Inter-rater reliability was assessed using inter-class coefficient (ICC). Thirteen clinical practice guidelines were critically reviewed. The Spanish clinical practice guidelines, American Academy of Pediatrics, and National Institute for Health and Clinical Excellence clinical practice guidelines consistently scored high on all AGREE domains (total averaged domain scores 90, 88, and 88, respectively). Among the six reviewers, there was a high degree of inter-rater reliability (average measure ICC 0.938; p<0.0001). There is reasonable consensus among the top three clinical practice guidelines in their major recommendations. The clinical practice guidelines from Spain, American Academy of Pediatrics, and National Institute for Health and Clinical Excellence, with their major recommendations being similar, have scored highly on the AGREE II indicators of quality for the clinical practice guidelines development process.

Randomized Trials in Children With UTI.

* Abbreviations: IV — : intravenous UTI — : urinary tract infection Randomized trials have played a pivotal role in shaping the management of pediatric urinary tract infections (UTIs). In important recent trials, authors have demonstrated that oral antibiotics are as effective as intravenous (IV) antibiotics1 and that prophylactic antibiotics do not prevent renal scarring.2 Given multiple ongoing controversies in the diagnosis and management of UTIs, however, still more trials are needed. In this issue of Pediatrics , Basmaci et al3 report a systematic review of 40 trials published between 1990 and 2016 involving 4381 UTI cases. They highlight the numerous inconsistencies in inclusion criteria and choice of end points in published UTI antibiotic trials and suggest that more uniformity is required. The lack of uniform inclusion criteria across trials reflects an ongoing controversy over the definition of UTI.4 Because of fear that some UTIs will be missed,5 there is reluctance to incorporate pyuria as a diagnostic criterion,6 despite the latest recommendation from the American Academy of Pediatrics UTI clinical practice guideline7 and subsequent supportive data that the urinalysis is more reliable than previously … Address correspondence to Alan R. Schroeder, MD, Department of Pediatrics, Division of Hospital Medicine, Stanford University School of Medicine, 300 Pasteur Dr, MC 5776, Stanford, CA 94305. E-mail: aschroe{at}stanford.edu

Urinary tract infection in Children Hospitalized at Constanta Clinical Infectious Diseases Hospital

Abstract Introduction: In pediatrics, the urinary tract infection is one of the most frequent bacterial infection, representing an important health problem due to its high incidence, wide etiology, asymptomatic evolution, and multiple and sever complications, relapses and sequelae.” Material and Method: We evaluated 45 children, aged between 6 months and 16 years, diagnosed and treated for urinary tract infection at the Clinical Infectious Diseases Hospital, of Constanta County, in a period of 3 years and 6 months. Results: During studied period, between January 2014 and June 2017 from a total of 9343 patients admitted to the Constanta Clinical Infectious Diseases Hospital, we selected 45 children (4.81‰) diagnosed with urinary tract infection. The average age of children with urinary tract infections was 5 years and 5 months. The gender distribution revealed a 2:1 balance in girl’s favor. The most affected group of age was 1-3 years. Fever was the dominating symptom. Urine cultures were positive for 37 cases, meanwhile for eight cases had been negative. The predominant germs are E. coli for female and for male Proteus. We noticed that for E. coli the highest sensitivity is preserved to Ertapenem -15 cases, followed by Ceftriaxone and Ciprofloxacin -10 cases each, and Gentamycin -9 cases. Conclusions: Pediatric urinary tract infection should be considered in every patient under 3 years with unexplained fever.

In-vitro Antibiotic Resistance Profile of E. coli Strains Isolated from Community-acquired Paediatric Urinary Tract Infections in Karabük Province

Amaç: Bu çalışmada Karabük ilinde çocuklarda toplum kaynaklı idrar yolu enfeksiyonuna neden olan E. coli suşlarının antibiyotik direnç profili ve Genişlemiş Spektrumlu Beta Laktamaz(GSBL) üretim oranlarının tespiti amaçlanmıştır. Gereç ve Yöntemler: Ocak 2013-Eylül 2016 tarihleri arasında Karabük Üniversitesi Karabük Eğitim Ve Araştırma Hastanesi Mikrobiyoloji Laboratuvarına çocuk polikliniklerinden gelen idrar örneklerinden izole edilen 410 E. coli çalışmaya dahil edilmiştir. E.coli suşlarının GSBL üretimi ve in-vitro antibiyotik direnç profili retrospektif olarak incelenmiştir. Bulgular: Toplum kökenli 410 üropatojen E. coli suşunun 328’i (%80) kız, 82 si (%20) erkek hastalardan izole edilmiştir. Tüm yaş gruplarında kız çocuklarında E.coli daha sık izole edilmiştir. Kız cinsiyet ile E.coli izolasyon oranları arasında tüm yaş gruplarında istatistiksel olarak anlamlı fark bulunmuştur.(p<0.05) E. coli suşları ampisiline %62.4, amoksisilin-klavulanik aside %40, trimetoprim sulfametoksazole %26, sefuroksime %23.6, sefiksime %15.8, sefotaksime %13.9, seftazidime %10.7, gentamisine %6, nitrofurantoine %5.8, ve fosfomisine % 4.1 oranında dirençli idi. Erkeklerde antibiyotik direnç oranları kızlardan yüksek bulunmuştur. Sefiksim, sefotaksim ve seftazidim direnç oranları ile erkek cinsiyet arasında istatistiksel olarak anlamlı fark olduğu tespit edilmiştir (p<0.05). Tüm izolatlar için GSBL oranı %13.9 olarak bulunmuştur. Bu oran kızlarda %11.5, erkeklerde %23.1 olarak tespit edilmiştir. Erkek cinsiyet ile GSBL üretim oranı arasında istatistiksel olarak anlamlı bir fark tespit edilmiştir. (p<0.001) Sonuç: İdrar yolu enfeksiyonu çocukluk çağında önemli bir problemdir. Yanısıra antibiyotik direnç oranları bölgeler arası önemli farklılıklar göstermektedir. Bölgemizde çocukluk çağı idrar yolu enfeksiyonlarının tedavisinde hem antibiyotik direnç oranları daha düşük olduğu için, hem de ağızdan alınabildikleri için sefiksim, nitrofurantoin ve fosfomisin tercih edilebilir.

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Getting to the root of the problem. Millions of newborn infants in Western Pacific still at risk. Deciphering molecular clues to paediatric urinary tract infection.

Clinical Significance of Extended-spectrum β-lactamase-producing Bacteria in First Pediatric Febrile Urinary Tract Infections and Differences between Age Groups

Purpose Extended-spectrum β-lactamase-producing bacteria-induced urinary tract infections are increasing and require more potent antibiotics such as carbapenems. We evaluated the clinical significance of extended-spectrum β-lactamase urinary tract infection in children younger than 5 years to select proper antibiotics and determine prognostic factors. Differences were compared between age groups. Methods We retrospectively studied 288 patients with their first febrile urinary tract infection when they were younger than 5 years. Patients were divided into extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative urinary tract infection groups. Clinical characteristics and outcomes were compared between the groups; an infant group was separately analyzed (onset age younger than 3 months). Results Extended-spectrum β-lactamase urinary tract infection occurred in 11 % patients who had more frequent previous hospitalization (P=0.02) and higher recurrence rate (P=0.045). During the antimicrobial susceptibility test, the extended-spectrum β-lactamase-positive urinary tract infection group showed resistance to third-generation cephalosporins; however, 98% patients responded clinically. In the infant group, extended-spectrum β-lactamase-positive urinary tract infection occurred in 13% patients and was associated with a longer pre-onset hospitalization history (P=0.002), higher C-reactive protein level (P=0.04), and higher recurrence rate (P=0.02) than that in the older group. Conclusion Extended-spectrum β-lactamase urinary tract infection requires more attention because of its higher recurrence rate. The antimicrobial susceptibility test demonstrated resistance to third-generation cephalosporins, but they can be used as first-line empirical antibiotics because of their high clinical response rate. Aminoglycosides can be second-line antibiotics before starting carbapenems when third-generation cephalosporins do not show bactericidal effects for extended- spectrum β-lactamase urinary tract infection. Key words: Extended-spectrum β-lactamase; Urinary tract infection; Age; Cephalosporin

Antibiotic Prescription Practice for Pediatric Urinary Tract Infection in a Tertiary Center

BackgroundUrinary tract infection (UTI) is a leading cause for acute care visits in pediatrics. A suspected UTI diagnosis is made based on typical clinical presentation and pyuria and confirmed by significant growth in an appropriate urine sample. Prescribing antibiotics for suspected UTI is a common practice, and may lead to unnecessary antibiotic exposure. We aimed to review the practice of UTI diagnosis and management in the Emergency Department (ED) to identify targets to improve antimicrobial prescribing practices.MethodsChildren (< 18 years) who were discharged from the ED at the Hospital for Sick Children with a diagnosis of UTI between October to December 2016 were included. Patients were excluded if they were (1) under 12 weeks of age, (2) had underlying genitourinary abnormalities, (3) were admitted or transferred to another center, (4) were on antibiotics on presentation, (5) had urine testing done in another laboratory, or (6) were given conditional prescription. Demographic, clinical history, laboratory findings, and urine culture results were collected from patient charts. The sensitivity and specificity of nitrite and leukocyte esterase (LE) for UTI diagnosis were calculated. Logistic regression was used to examine the relationship between urinalysis characteristics and confirmed UTI.ResultsA total of 186 children with a median age of 4.2 (IQR 1.2, 7.3) were included; 82.3% were female. Almost all children were discharged home on antibiotics (n = 183, 98%) for a median duration of 7 days (IQR 7, 10). A total of 87 patients (46.8%) received antibiotics despite negative urine cultures and none of these patients received notification to stop. This led to 652 unnecessary antibiotic days. The presence of nitrites was the strongest predictor of UTI (OR 13.3, P < 0.001) and was highly specific. An LE result of 2+ (OR 2.4, P = 0.04) or 3+ (OR 2.23, P = 0.016) was also predictive of UTI.ConclusionCurrent practice in managing suspected pediatric UTIs in our ED resulted in significant and unnecessary antibiotic exposure. We identified targets to reduce unnecessary antibiotic exposure including improving the diagnostic accuracy of UTIs, a process to discontinue antibiotics for negative cultures and standardizing antimicrobial duration.Disclosures All authors: No reported disclosures.