Resistance Patterns In Children Research Articles

Prevalence Of Rifampicin Resistance in New Cases Of Pulmonary Tuberculosis In Children

Objective: The research aims to determine the prevalence of rifampicin resistance in newly diagnosed pediatric pulmonary tuberculosis cases, investigating the frequency of resistance to this first-line antibiotic. By doing so, it seeks to provide insights into rifampicin's effectiveness as a treatment and contribute to understanding drug-resistant tuberculosis in children. Methods: The investigation employed a cross-sectional design to evaluate the presence of rifampicin resistance in newly diagnosed pediatric pulmonary tuberculosis cases. Executed in Lahore, Pakistan, it adopted a convenience sampling strategy with a sample size of 100. The research entailed screening children displaying symptoms of TB, acquiring written consent, and gathering demographic and clinical data, encompassing bacterial load and evidence of antibiotics. Sputum samples were processed employing the Xpert MTB/RIF assay. Statistical analyses, encompassing descriptive statistics and prevalence calculations, were executed utilizing the SPSS software. The investigation underscored the significance of resilient diagnostics, early identification, and tailored interventions for the management of drug-resistant TB in children. Results: The study provides valuable insights into rifampicin resistance among children with pulmonary tuberculosis. These findings highlight the importance of regular monitoring and appropriate treatment strategies to combat drug-resistant tuberculosis in pediatric populations. Further research and interventions are warranted to minimize the emergence and spread of drug-resistant strains in this vulnerable population. Conclusion: The study highlights the need for continuous monitoring of drug resistance patterns in children with tuberculosis, particularly concerning rifampicin, a crucial first-line antibiotic. The higher resistance rate suggests exploring alternative treatment options, optimising drug regimens, and developing interventions to prevent and manage drug-resistant tuberculosis effectively in children. Keywords: Antibiotics, Disease, Paeds, Resistance, Susceptibility, Tuberculosis.

The causes of bacterial bloodstream infections and antimicrobial resistance patterns in children attending a secondary care hospital in Bhaktapur, Nepal, 2017-2022: a retrospective study.

Data on antimicrobial resistance (AMR) among children in Nepal are limited. Here we have characterized the causes of bacterial bloodstream infections (BSIs), antimicrobial resistance patterns and the mechanisms of β-lactamase production in Enterobacterales among children attending outpatient and inpatient departments of a secondary care paediatric hospital in Nepal. We retrospectively collected demographic and clinical data of culture-proven bacterial BSIs between January 2017 and December 2022 among children <18 years attending a 50-bedded paediatric hospital. Stored isolates were subcultured for antimicrobial susceptibility testing against commonly used antimicrobials. Enterobacterales displaying non-susceptibility to β-lactams were phenotypically and genotypically investigated for ESBLs, plasmid-mediated AmpC (pAmpC) β-lactamases and carbapenemases. A total of 377 significant bacteria were isolated from 27 366 blood cultures. Among 91 neonates with a BSI, Klebsiella pneumoniae (n = 39, 42.4%), Pseudomonas aeruginosa (n = 15, 16.3%) and Acinetobacter baumannii complex (n = 13, 14.1%) were most common. In the non-neonates, 275/285 (96.5%) infections were community-acquired including Staphylococcus aureus (n = 89, 32.4%), Salmonella Typhi (n = 54, 19.6%) and Streptococcus pneumoniae (n = 32, 11.6%). Among the 98 S. aureus, 29 (29.6%) were methicillin-resistant Staphylococcus aureus. K. pneumoniae and Escherichia coli demonstrated non-susceptibility to extended-spectrum cephalosporins and carbapenems in both community and hospital-acquired cases. For E. coli and K. pneumoniae, blaCTX-M (45/46), blaEBC (7/10) and blaOXA-48 (5/6) were common among their respective groups. We determined significant levels of AMR among children attending a secondary care paediatric hospital with BSI in Nepal. Nationwide surveillance and implementation of antimicrobial stewardship policies are needed to combat the challenge imposed by AMR.

Urinary Tract Infections in Children: Clinical and Antibiotic Susceptibility Data from a Tertiary Care Hospital

Aim: Urinary tract infections (UTIs) are among the most common bacterial infections in children.&#x0D; Empirical antibiotic treatment is recommended until the antibiogram reports of urine culture are&#x0D; available. It is essential to initiate local UTI agents and their antimicrobial susceptibility patterns in&#x0D; specific geographical regions to choose the best empirical antibiotics. The current study aimed to&#x0D; determine causative microorganisms and antibiotic resistance patterns in children diagnosed with UTI.&#x0D; Material and Methods: The study was carried out retrospectively with 216 children diagnosed with&#x0D; UTIs for the first time. The patients were categorized into two groups according to age (≤1 year and &gt;1&#x0D; year). Demographic data, presenting symptoms, imaging findings, and urine and culture analysis results&#x0D; were collected and compared between these two groups.&#x0D; Results: Cefazolin and nitrofurantoin use may be preferred in the empirical treatment of UTIs caused&#x0D; by Escherichia coli and Enterococcus spp. Additionally, amoxicillin/clavulanate was recommended in&#x0D; the empirical therapy of UTIs caused by Enterococcus spp., Klebsiella spp., and Proteus spp. The&#x0D; trimethoprim-sulfamethoxazole and nitrofurantoin resistance of E. coli was found to be statistically&#x0D; significantly higher in the ≤1 year group (p=0.03 and p=0.01, respectively), while the nitrofurantoin&#x0D; resistance of Klebsiella was statistically significantly higher in the &gt;1 year group (p=0.01). The gentamicin&#x0D; resistance of Klebsiella spp. was statistically significantly higher in the ≤1 year group (p=0.03).&#x0D; Conclusion: It is important to detect regional antibiotic resistance patterns to manage UTIs and minimize&#x0D; related complications. Antibiotic susceptibility studies are necessary to reduce improper antibiotic use&#x0D; and resistance rates of antibiotics.

P273 Chronic airway infection and resistance pattern in children and adults with cystic fibrosis in Oman. A single centre cross sectional study

To assess the pattern of airway bacterial growth among cystic fibrosis (CF) patients in Oman, and to identify possible risk factors for the hypothesize early Pseudomonas aeruginosa (PA) acquisition among these children.

554 Development of a cystic fibrosis–specific antibiogram evaluating antimicrobial susceptibility and resistance patterns in children, adolescents, and young adults

554 Development of a cystic fibrosis–specific antibiogram evaluating antimicrobial susceptibility and resistance patterns in children, adolescents, and young adults

559 Inhaled antibiotics and resistance patterns in children with cystic fibrosis: A retrospective, single-center study

559 Inhaled antibiotics and resistance patterns in children with cystic fibrosis: A retrospective, single-center study

Acute Otitis Media in Children-Challenges of Antibiotic Resistance in the Post-Vaccination Era.

Acute otitis media (AOM) is a leading cause of antibiotic prescriptions in children worldwide, even in the era of pneumococcal conjugate vaccines. We aimed to assess the bacterial spectrum of AOM in children and to investigate the antimicrobial resistance profile in culture-positive cases. We performed a retrospective, tympanocentesis-based analysis of antimicrobial resistance patterns in children with AOM hospitalized in “St Mary” Emergency Hospital for Children Iasi, Romania, between January 2013 and December 2021. A total of 147 samples have been assessed, 97 (65.98%) of which had positive cultures, with Streptococcus pneumoniae and Haemophilus influenzae as the most common microorganisms. A worrying proportion, 82.85% (58/70), of the Streptococcus pneumoniae strains were multidrug-resistant. The World Health Organization included Streptococcus pneumoniae and Haemophilus influenzae on the medium priority group due to penicillin non-susceptibility and ampicillin-resistant strains, respectively. Consequently, strategies to address the threats of antimicrobial resistance are needed to reduce the potential negative effects on hospitalization costs.

Bacteriological Profile and Antibiotic Resistance Pattern in Children with Urinary Tract Infection in a Tertiary Care Hospital

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections seen in children. The knowledge of bacterial causes of UTIs and their antimicrobial resistance patterns may help clinicians in choosing the appropriate antimicrobials.&#x0D; Objectives: The present study was designed to find out the bacteriological profile of urinary tract infection and their antibiotic resistance pattern in children.&#x0D; Methodology: A cross sectional study was done in the department of Microbiology, Sir Salimullah Medical College from January to December 2019. Midstream urine samples were collected from clinically suspected cases of UTI in the age group of 0 to 18 years from various indoor and outdoor patients of Mitford hospital for this study.&#x0D; Results: Out of 2763 cases, 363 were culture positives, where females were 202(55.65%) with highest number of cases within the age group of 0 to 4 years (63.36%). Most common isolate identified was Escherisia coli, followed by Pseudomonas, Proteus, Morganella and only Gram positive bacteria was S. aureus. Organisms show highest resistance to Amoxiclav, Cefixime, Cotrimoxazole, Ciprofloxacin and highest sensitivity to Amikacin.&#x0D; Conclusion: This study revealed that UTI was more common in female &amp; under five children. Escherichia coli were the commonest isolated organism and all isolates show high resistance to common antimicrobial agents.&#x0D; Sir Salimullah Med Coll J 2021; 29(2): 112-116

14-year trends and resistance patterns of blood and cerebrospinal fluid cultures in children under three years old

Bacterial infections are a major cause of UK paediatric hospitalisations, yet longitudinal data on causative organisms or antimicrobial resistance are scarce. This retrospective analysis describes trends in blood and cerebrospinal fluid (CSF) cultures and resistance patterns in children under three years old from a large UK centre. All culture results, and resistance data for Gram-negative rods (GNR) in blood cultures, collected between January 2005 and December 2018 were extracted from Oxford University Hospitals NHS Foundation Trust microbiology database. Of 49,298 samples, 6.7% of blood and 3.1% of CSF cultures were positive for bacterial growth; 2.3% and 1.1%, respectively grew pathogens. Number of cultures taken increased over time; the proportion growing pathogens declined. Resistance of GNR to first-line antimicrobials was 9.3% to gentamicin (neonatal units), and 17.1% and 25.8% to ceftriaxone (paediatric ED and wards respectively). Resistance to any two of ceftriaxone, ciprofloxacin, gentamicin, or meropenem was ≤6% in both areas. The proportion of positive cultures declined over time. Resistance of GNR to empirical antimicrobials were observed, but resistance to a second agent were lower. Our study informs clinician decisions on when, and to which antimicrobials, to escalate if a child is not improving on empirical therapy.

Evaluation of urinalysis and urine culture in children with first-time urinary tract infection.

This study aimed to review results of urinalysis with flow cytometry technique at the time of diagnosis of urinary tact infection (UTI), and to determine uropathogenes with their antibiotic resistance patterns in children with first-time UTI. This single-centered, retrospective, cross-sectional study was conducted from January 2015 to December 2017. The study included 361 children with a first-time UTI diagnosis. Age, gender, results of automated urinalysis, urine culture results were recorded. Mean ages of children were 55.8±50.7 months. E. coli was the most common isolated microorganism followed by K. pneumoniae, Proteus, Enterococcus, and P. aeroginosa. Median count of pyuria was 44 leukocyte/mm3 (range:0-2954/mm3). Median count of pyuria in female and male patients were 53 and 22 leukocyte/mm3, respectively (p=0047). A total of 98 patients (27.1%) had no pyuria. Proportion of pyuria in female and male patients were 81.2% and 76%, respectively (p>0.05). Mean age of patients with and without pyuria were 59±52 months and 46±44months, respectively (p<0.05). According to uropathogen, there was pyuria at the ratio of 60% in Pseudomonas, 62.5% in Enterococcus spp, 66.7% in Proteus, 78.3% in Klebsiella, and 82.7% in E. coli. Children with UTI induced by E. coli had resistance ratios of 30.5% and 22.4% to cefixime and ceftiaxone, respectively. Children with UTI by Klebsiella spp had resistance ratios of 47.8% and 39.1% to cefixime and ceftriaxone, respectively. E. coli was the most common uropathogen in children with first-time UTI. Pyuria may be lacking according to age, gender, and type of uropathogene. Pyuria level was higher in females. In addition, ceftriaxone and cefixime resistance is increasing making ampirical treatment choices limited.

1366. Microbiology of Acute Hematogenous Osteomyelitis in Hospitalized Children

BackgroundAcute hematogenous osteomyelitis affects 1 in 5,000 children in the U.S. and Staphylococcus aureus is the most common bacterial cause. At our institution, clindamycin is used empirically for osteomyelitis, despite increasing clindamycin-resistance over the years. The objective of this study is to describe microbiologic results and antibiotic resistance patterns in children hospitalized with acute hematogenous osteomyelitis.MethodsThis was a single-center retrospective cohort study of patients < 21 years of age with acute osteomyelitis hospitalized between 1/1/2010 and 5/31/2019 at Children’s National Hospital. We excluded patients with recent orthopedic surgery, hardware infection, penetrating trauma, or with an underlying immunocompromising condition. We performed chart review to collect data on location of infection; blood, synovial fluid, or surgical site cultures; culture results, and susceptibilities.ResultsOf the 162 encounters of acute osteomyelitis that met inclusion criteria, the average patient age was 8.3 years. Lower extremity infections were most common (105, 64.8%), followed by upper extremity (31, 19.1%), pelvis (14, 8.6%), spine (7, 4.3%), shoulder (4, 2.5%), rib (1, 0.6%) and mandible (1, 0.6%). Almost half of cases (73, 45%) had no positive cultures, and 89 cases (55%) had at least one positive culture from blood or local source (Figure 1). The most common pathogen was methicillin susceptible S. aureus (MSSA) followed by methicillin resistant S. aureus (MRSA) comprising 60 (67%) and 19 (20%) of culture-positive infections respectively. Other isolated pathogens included S. pyogenes (5, 5.6%) Salmonella species (2, 2.2%), S. pneumoniae (1, 1.1%), S. agalactiae (1, 1.1%), and Kingella kingae (1, 1.1%) (Figure 1). Among S. aureus infections, 69 (87%) were susceptible to clindamycin (85% among MSSA, 95% among MRSA).Categorized Blood and Wound Culture Results ConclusionAlmost half of all children with acute hematogenous osteomyelitis did not have any microbiologic data to guide antibiotic usage. S. aureus was the most common (87%) isolate, with more MSSA (74%) than MRSA (24%). Non-S. aureus isolates were more likely to grow from surgical specimen cultures than from blood cultures. Clindamycin resistance was more commonly seen in MSSA than in MRSA osteomyelitis.Disclosures All Authors: No reported disclosures

The Comparison of Staphylococcus aureus Nasal Colonization and Its Antibiotic Resistance Patterns in Children of Health Care Workers (HCWs) and Non-HCWs

Background: Staphylococcus aureus is a gram-positive coccus bacterium responsible for a wide spectrum of human infections. The main colonization site for S. aureus in humans is the anterior nares. Health care workers (HCW) are commonly colonized with resistant microorganisms; however, it is not clear whether close contact with HCW is a risk factor for colonization with resistant microorganisms. Objectives: The aim of the study was the determination of the risk of methicillin-resistant Staphylococcus aureus transmission from colonized parents to their children via daily contact. Methods: This was a cross-sectional study conducted in Hamadan city, the west of Iran, between October 2016 and March 2017. We defined two groups for our investigation. The first group included 1 - 6 years old children who their mother, father, or both were health care workers (HCW) in university-affiliated hospitals of Hamadan University of Medical Sciences, and the second group consisted of children whose parents were not health care workers. Both groups attended day care centers. One hundred and thirty-four children were enrolled in this study, from which 67 had HCW parents, and 67 had non-HCW parents. Results: S. aureus colonization rate among children of HCWs was 17.9 % (12/67), and in children of non-HCWS was 32.8% (22/67). The colonization rate was not significantly different between these 2 groups (P = 0.052). Of all the S. aureus isolates, one methicillin-resistant isolate and one clindamycin-resistant isolate were observed. The D-test was positive in 12.1% of clindamycin sensitive isolates Conclusions: We recommend the use of anti-staphylococcal penicillin or first-generation cephalosporins in cases of non-life-threatening staphylococcal infections and clindamycin for MRSA infections. Regarding to our results, there is no difference in the choice of antibiotic between children of health care workers and other children. We also recommend avoiding switching therapy from erythromycin to clindamycin.

Evaluation of Microbial Resistance Pattern in Children with Urinary Tract Infection in Bushehr between 2017 and 2018

Background and Aim: Urinary tract infection is one of the most common childhood illnesses that can lead to complications such as hypertension and kidney failure. The aim of this study was to evaluate microbial resistance and sensitivity and to determine the relationship between urinary tract abnormalities and prior antibiotic use with microbial resistance. Methods: This is a descriptive-analytic study on 90 patients with a positive urine culture. Urine culture samples were taken using one of the sampling methods (midstream clean catch, catheterization, urine bag, suprapubic aspiration) and ultrasonography was requested for all patients to evaluate urinary system abnormalities. Also, a history of prior antibiotic use was asked and recorded. Results: Of all patients, 55.6% showed E.coli and 44.4% showed other bacteria in urine culture. 97.7% of patients' cultures were sensitive to imipenem, 82.2% to nitrofurantoin, and 77.8% to cefixime. 65% of patients' cultures showed resistance to nalidixic acid, 56.7% to co-trimoxazole, and 38.9% to ceftriaxone. There was a significant relationship between cefixime and amikacin antibiotic resistance with abnormal ultrasound and there was a significant relationship between antibiotic resistance to cefixime, ceftriaxone, co-trimoxazole, and duration of prior antibiotic use (p-value <0.05). Conclusion: The most common pathogen in UTI was E.coli. The highest sensitivity was to imipenem, nitrofurantoin, and cefixime, and the highest resistance was to nalidixic acid, co-trimoxazole, and ceftriaxone. There was a relationship between urinary tract abnormalities and prior antibiotic use with microbial resistance, so it is suggested to use kidney ultrasound in all patients with urinary tract infection.

Second-line antiretroviral therapy failure and characterization of HIV-1 drug resistance patterns in children in Mali

IntroductionIn recent years, children born to HIV-infected mothers have been receiving antiretroviral treatment (ART) with limited or no virologic monitoring, which increases the likelihood of development and accumulation of drug resistance mutations, which itself may limit the effectiveness of future ART. The objective of this study was to evaluate the prevalence of resistance mutations in children infected with HIV-1 experiencing virological failure to second-line ART in the Pediatric Department of Gabriel Touré Hospital in Mali. MethodsChildren aged from 5 to 18 infected with HIV-1 on second-line antiretroviral therapy and whose viral load was greater than 1000 copies/mL after observance reinforcement were enrolled. The protease and reverse transcriptase genes were sequenced with ViroSeq®. The results were interpreted according to the last version of the Stanford algorithm in 2018. The study was approved by the Ethics Committee of the Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako (Mali). ResultsOf 216 children, 33 (15.3%) who had a viral load (VL)>1000 copies/mL in second line were recruited and included in the study. The median plasma viral load was 77,000 copies/mL [IQR (28,000–290,000)] and the median CD4 cell count was 310 cells/mm3 [IQR (152–412)]. The median age was 12 years; 48.5% of patients were treated with a combination of stavudine/lamivudine/nevirapine (Triomune®) for first-line treatment and 60.6% with abacavir/lamivudine/lopinavir/ritonavir for the second-line ART. The median treatment duration was 8.5 years [range, 3–13]. Of the 33 children whose treatment failed, the predominant HIV-1 subtype was CRF02_AG (66.7%). The prevalence of resistance to ART classes was 60.61% (20/33) to nucleoside reverse transcriptase inhibitors (NRTIs), 54.51% (18/33) to nonnucleoside reverse transcriptase inhibitors (NNRTIs), and 51.52% (17/33) to protease inhibitors (PIs). Of the patients studied, 90.9% were exposed to lopinavir/ritonavir (LPV/r) but only 15.2% (5/33) developed resistance to LPV/r. ConclusionsThis study demonstrated that LPV/r remains active in most patients after second-line ART failure. In children whose second-line ART fails, particular attention should be paid to their ART and adherence history when considering the next treatment option.

Community-acquired urinary tract infections in children: Resistance patterns of uropathogens in a tertiary care center in Saudi Arabia.

ObjectiveThe aim of the present study was to investigate the bacterial pathogens and their resistance patterns in children presenting with their first admission for a urinary tract infection (UTI) in a large tertiary care center in Riyadh, Saudi Arabia.MethodsA retrospective chart review was conducted of pediatric patients 0–14 years of age who were admitted for their first community-acquired UTI in a large tertiary care center in Riyadh, Saudi Arabia. The review covered a 6-year period (2006–2012).ResultsData were obtained from 202 children, of which 162 (80.2%) were female. The most frequently isolated uropathogens were Escherichia coli (75.7%), followed by Klebsiella pneumoniae (9.4%), Pseudomonas aeruginosa (5.9%) and Enterococcus species (3.5%). Sixteen (7.9%) isolates were ESBLs. Among all uropathogens, 68% were resistant to ampicillin, 54% resistant to co-trimoxazole, and 30% resistant/intermediate sensitivity to amoxicillin/clavulinic acid. Overall, there was a low resistance rate to cefotaxime (4.4%).ConclusionE. coli is the predominant uropathogen causing UTIs in children, yet there is a high rate of multidrug-resistant organisms. For children admitted for a community-acquired UTI, a third-generation cephalosporin remains an appropriate empiric antibiotic. Our study and the work of others emphasize the importance of choosing empiric antibiotics for pediatric UTIs based on local resistance patterns.

Antiretroviral Resistance Patterns in Children with HIV Infection.

To provide an update on the patterns of HIV drug resistance in children, including pretreatment drug resistance (PDR) and acquired drug resistance (ADR), focusing on children in low- and middle-income countries (LMICs) for whom empiric first-line (FL) and second-line (SL) antiretroviral regimens are usually recommended. High levels of PDR, particularly to non-nucleoside reverse transcriptase inhibitors (NNRTIs), and poor treatment outcomes on NNRTI-based FL antiretroviral therapy (ART) have been widely reported among infants and young children. There is a paucity of recent data on the use of protease inhibitor (PI)-based FL and SL regimens in children, but studies have reported poor tolerability, adherence problems and the development of PI resistance. Limited access to virological monitoring and HIV drug resistance testing contributes to delays in identifying treatment failure due to ADR and delays in switching to SL regimens in children. Implementation of FL ART regimens that have a higher barrier to developing resistance and are safe and well tolerated is required in order to attain global treatment targets. Although PI-based regimens may be effective as FL or SL treatment in children, lack of appropriate formulations leading to poor tolerability, drug-drug interactions, and cost considerations have negatively impacted their use among children in LMICs. There is hope that dolutegravir-based regimens recommended for children by the World Health Organization will be widely implemented once child-friendly formulations are available, and dosing and safety studies currently underway are completed, and that this will significantly improve treatment outcomes.

Antibiotic Resistance Pattern in Children with UTI: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses the child, concerns the parents, and may cause permanent kidney damage. Occurrences of a first-time symptomatic UTI are highest in boys and girls during the first year of life and markedly decrease after that. Febrile infants younger than 2 months constitute an important subset of children who may present with fever without a localizing source. For resistance knowledge of etiology pathogens of UTIs and their antimicrobial resistance patterns in specific geographical location may help clinicians in choosing the appropriate antimicrobial. Our aim was to assess bacteriological profile and antibiotic resistance pattern in pediatric UTI. A cross sectional study was conducted at Dhaka Shishu Hospital during the period from Feb 2016 to Aug 2016. A total of 147 culture positive UTI patient were considered for analysis. Colony counts for these samples were identified, and the profile of antibiotic resistance was identified. Here, samples with a colony count of ≥105 CFU/mL bacteria were considered positive. A total 147 culture positive UTI patients were enrolled. Here, Escherichia coli (E-coli) was found as the most prevalent isolates 103 (70%) followed by Klebsiella spp. 13.6%, Pseudomonas 5.44%, Enterobacter spp 3.40%, Staphylococcus Aureus 3.40%, Proteus 2.72% and Enterococcus 1.36%. Twelve (12) antimicrobial agents were used for antimicrobial susceptibility testing. The most resistant drugs we found were Colistin (CL) (94.55%), followed by Cefradine (79.59%), Co-trimoxazole (SXT) (69.39%), Nalidixic acid (NA) (66.67%) and Ceftazidime (CTM) (48.98%). None of the drug found was 100% resistance against urinary pathogens. Antimicrobial drug resistance is decreasing among urinary pathogens. We suggest that, empirical antibiotic selection should be based on knowledge of the local prevalence of bacterial organism and their antibiotic resistance in a specific area rather than on universal or even national guidelines.

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.

Investigating the Prevalence of Shigella Species and Their Antibiotic Resistance Pattern in Children With Acute Diarrhea Referred to Selected Hospitals in Tehran, Iran

Introduction: Shigellosis is a major health problem, especially in developing countries and in children under 5 years of age. The prevalence of Shigella species in a region can be considered as an indicator for hygiene level of that region. Due to the lack of an efficient vaccine, antibiotic therapy is the main strategy to combat the disease. In this study, the prevalence of the Shigella species and their antibiotic resistant pattern has been investigated. Materials and Methods: A total of 300 diarrheal stool samples were collected from 4 different hospitals in Tehran during a period of 6 months June to November 2016. Bacterial identification and species discrimination was performed using biochemical and serotyping tests. Antibiotic resistance patterns of isolates were obtained using Bauer-Kirby method. Results: 8.7% of all diarrheal cases were caused by Shigella species (5% by Shigella sonnei and 3.7% by Shigella flexneri). Antibiogram test revealed that the isolates were more sensitive or intermediate to ciprofloxacin (92.3%), while most of the isolates were resistant to tetracycline. Conclusions: The prevalence of Shigella species has changed in Tehran. Since antibiotics are the treatment of choice to combat these pathogens, also, because of the emergence of the antibiotic resistance Shigella strains, there is a need for regularly updated regional antibiotic sensitivity patterns of the pathogen to guide therapy.

Diagnosis and Antibiotic Resistance Distribution in Children with Urinary Tract Infection: A Single Center Experience

Background: Urinary tract infection is a common disease in childhood. The aim of this study was to determine the diagnostic performance of urinary analysis, assess the role of urine culture in determining its necessity and evaluate etiologic agents and antimicrobial resistance patterns in children with urinary tract infection.Methods: Our study was made by evaluating the patients who applied to the Antalya Research and Training Hospital- Turkey, between 2015 and 2017. A total 237 urine analysis and urine culture were retrospectively analyzed. Culture results were taken a reference for microscopic and chemical examination of urine and diagnostic accuracy of the test parameters, and the performance of urine analysis were calculated. The culture and antibiogram results were examined and antibiotic resistance with infectious agents frequency was evaluated.Results: The 42.4% of culture negative samples showed leukocyte esterase, nitrite, bacterial and leukocyte counts, which are indicative of infection in urine analysis, were found in normal range. The highest sensitivity (90%) was in the presence of leucocyte esterase and bacteria, while the highest specificity (99.4%) was in the presence of nitrite alone or with other components (leucocyte or leucocyte esterase). The highest antibiotic resistance was found in beta lactam antibiotics. The lowest antibiotic resistance was detected in the carbapenem followed by fluoroquinolone group antibiotics.Conclusion: Microscopic and chemical examination of urine analysis can give us information about urine culture requirement. The observation of increasing overall resistance to antibiotics authorize further studies that lead to new recommendations to antibiotic use in children and adolescents.