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Kawalec A, Józefiak J, Kiliś-Pstrusińska K. Urinary Tract Infection and Antimicrobial Resistance Patterns: 5-Year Experience in a Tertiary Pediatric Nephrology Center in the Southwestern Region of Poland. Antibiotics (Basel) 2023; 12:1454. [PMID: 37760750 PMCID: PMC10525788 DOI: 10.3390/antibiotics12091454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Urinary tract infections (UTIs) are among the most common infections in the pediatric population. This study aimed to analyze the urine culture results and antimicrobial patterns over the last 5 years in children diagnosed with UTI. (2) Methods: Retrospective analysis of medical records of 242 patients hospitalized in the Pediatric Nephrology Department diagnosed with a UTI in the years 2018-2022. (3) Results: The most common causative agent was E. coli, responsible for 64% of UTIs, followed by Klebsiella spp. (16%), Pseudomonas spp. (6%), Enterobacter spp. (4%), Proteus spp. (4%), and Enterococcus spp. (3%). Non-E. coli UTIs were significantly more frequently observed in patients with congenital anomalies of the kidney and urinary tract or neurogenic bladder and patients receiving antibiotic prophylaxis. For the whole study period, 32% of E. coli were resistant to amoxicillin/clavulanic acid, 23.3% to trimethoprim/sulfamethoxazole, 12.2% to ciprofloxacin, and 4.4% to nitrofurantoin. During 2018-2022, the prevalence of E. coli resistant to amoxicillin/clavulanic acid varied from 16.7% to 41.2%, and resistance to cefuroxime increased four times (from 4% in 2018 to 16.7% in 2022). Starting in 2021, all isolated E. coli strains were classified as susceptible-increased exposure or resistant to cefuroxime. (4) Conclusion: Managing pediatric UTIs remains challenging in clinical practice. The choice of optimal empiric treatment should be considered following local recommendations and individual risk factors assessment and require careful dosage adjustment. Observed changes in antimicrobial resistance indicated the need for frequent updating of local recommendations for the management of pediatric patients with UTIs.
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Affiliation(s)
- Anna Kawalec
- Clinical Department of Pediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
- Clinic of Pediatric Nephrology, University Hospital in Wroclaw, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Justyna Józefiak
- Clinic of Pediatric Nephrology, University Hospital in Wroclaw, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Katarzyna Kiliś-Pstrusińska
- Clinical Department of Pediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
- Clinic of Pediatric Nephrology, University Hospital in Wroclaw, Borowska Street 213, 50-556 Wroclaw, Poland
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Tao G, Tan H, Chen Q. The First Report of Escherichia coli and Klebsiella pneumoniae Strains That Produce Both NDM-5 and OXA-181 in Jiangsu Province, China. Infect Drug Resist 2023; 16:3245-3255. [PMID: 37249963 PMCID: PMC10225149 DOI: 10.2147/idr.s412678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
Objective The aim of this study was to analyze the genetic characteristics of three Enterobacteriaceae strains (one strain of Escherichia coli and two strains of Klebsiella pneumoniae) that produce both the NDM-5 and OXA-181 carbapenemases in pediatric patients. Methods Carbapenem-resistant Enterobacteriaceae (CRE) strains were collected from the Children's Hospital Affiliated to Nanjing Medical University in 2022. Resistance genes were detected by PCR. CRE strains that produced both the blaNDM-5 and blaOXA-181 genes were further characterized by antimicrobial susceptibility testing, multilocus sequence typing (MLST), plasmid conjugation assay, S1 nuclease-PFGE, Southern blotting and whole-genome sequencing. Results Three Enterobacteriaceae strains carrying both the blaNDM-5 and blaOXA-181 resistance genes were screened. MLST results showed that the strain of Escherichia coli carrying both blaNDM-5 and blaOXA-181 was ST410; the two strains of Klebsiella pneumoniae with both blaNDM-5 and blaOXA-181 were ST2601 and ST759. Conjugation assays showed that the plasmids harboring the blaNDM-5 and blaOXA-181 genes were self-transmissible. S1-PFGE and Southern blotting showed that the blaNDM-5 and blaOXA-181 genes were located on the plasmid with the size of about 60kb~. The genotyping results showed that the plasmid types were ColKP3 and IncX3. Conclusion This is the first report of Enterobacteriaceae strains that produce both NDM-5 and OXA-181 isolated from pediatric patients in China. Active infection control measures are urgently needed to prevent the spread of bacteria in children.
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Affiliation(s)
- Guixiang Tao
- Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Hua Tan
- Department of Clinical Laboratory, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Qian Chen
- Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Bagnasco F, Piaggio G, Mesini A, Mariani M, Russo C, Saffioti C, Losurdo G, Palmero C, Castagnola E. Epidemiology of Antibiotic Resistant Pathogens in Pediatric Urinary Tract Infections as a Tool to Develop a Prediction Model for Early Detection of Drug-Specific Resistance. Antibiotics (Basel) 2022; 11:antibiotics11060720. [PMID: 35740127 PMCID: PMC9220059 DOI: 10.3390/antibiotics11060720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Antibiotic resistance is an increasing problem, especially in children with urinary tract infections. Rates of drug-specific resistant pathogens were reported, and an easy prediction model to guide the clinical decision-making process for antibiotic treatment was proposed. Data on microbiological isolation from urinoculture, between January 2007−December 2018 at Istituto Gaslini, Italy, in patients aged <19 years were extracted. Logistic regression-based prediction scores were calculated. Discrimination was determined by the area under the receiver operating characteristic curve; calibration was assessed by the Hosmer and Lemeshow test and the Spiegelhalterz test. A total of 9449 bacterial strains were isolated in 6207 patients; 27.2% were <6 months old at the first episode. Enterobacteriales (Escherichia coli and other Enterobacteriales) accounted for 80.4% of all isolates. Amoxicillin-clavulanate (AMC) and cefixime (CFI) Enterobacteriales resistance was 32.8% and 13.7%, respectively, and remained quite stable among the different age groups. On the contrary, resistance to ciprofloxacin (CIP) (overall 9.6%) and cotrimoxazole (SXT) (overall 28%) increased with age. After multivariable analysis, resistance to AMC/CFI could be predicted by the following: sex; age at sampling; department of admission; previous number of bacterial pathogens isolated. Resistance to CIP/SXT could be predicted by the same factors, excluding sex. The models achieved very good calibration but moderate discrimination performance. Specific antibiotic resistance among Enterobacteriales could be predicted using the proposed scoring system to guide empirical antibiotic choice. Further studies are needed to validate this tool.
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Affiliation(s)
- Francesca Bagnasco
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
- Correspondence:
| | - Giorgio Piaggio
- Division of Nephrology, Dialysis, and Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Alessio Mesini
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Marcello Mariani
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genova, Italy
| | - Chiara Russo
- Infectious Diseases Unit, Ospedale Policlinico San Martino IRCCS, 16132 Genova, Italy;
| | - Carolina Saffioti
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Giuseppe Losurdo
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
| | - Candida Palmero
- Clinical Pathology Laboratory and Microbiology, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Elio Castagnola
- Infectious Disease Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy; (A.M.); (M.M.); (C.S.); (G.L.); (E.C.)
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Esposito S, Maglietta G, Di Costanzo M, Ceccoli M, Vergine G, La Scola C, Malaventura C, Falcioni A, Iacono A, Crisafi A, Iughetti L, Conte ML, Pierantoni L, Gatti C, Caminiti C, Biasucci G. Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy. Antibiotics (Basel) 2021; 10:antibiotics10101207. [PMID: 34680787 PMCID: PMC8532648 DOI: 10.3390/antibiotics10101207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/23/2022] Open
Abstract
The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between 1 January 2012, and 30 June 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-903524
| | - Giuseppe Maglietta
- Research and Innovation Unit, University Hospital, 43126 Parma, Italy; (G.M.); (C.C.)
| | - Margherita Di Costanzo
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy; (M.D.C.); (G.B.)
| | - Martina Ceccoli
- Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (M.C.); (L.I.)
| | - Gianluca Vergine
- Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy; (G.V.); (M.L.C.)
| | - Claudio La Scola
- Paediatric Clinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | | | - Alice Falcioni
- Paediatric Unit, Forlì Hospital, AUSL Romagna, 47121 Forlì, Italy;
| | - Alessandra Iacono
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy;
| | - Antonella Crisafi
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Lorenzo Iughetti
- Paediatrics Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy; (M.C.); (L.I.)
| | - Maria Luisa Conte
- Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy; (G.V.); (M.L.C.)
| | - Luca Pierantoni
- Paediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Claudia Gatti
- Paediatric Surgery, University Hospital, 43126 Parma, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital, 43126 Parma, Italy; (G.M.); (C.C.)
| | - Giacomo Biasucci
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29122 Piacenza, Italy; (M.D.C.); (G.B.)
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