Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: Relative frequency, risk factors, antimicrobial resistance and outcome

Nir Marcus, Shai Ashkenazi, Arnon Yaari, Zmira Samra, Gilat Livni

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

Background: Currently hospitalization for children with urinary tract infections (UTIs) is reserved for severe or complicated cases. Changes may have taken place in the characteristics and causative uropathogens of hospital-treated community-acquired UTI. Objectives: To study children hospitalized in a tertiary center with community-acquired UTI, compare Escherichia coli and non-E. coli UTI, define predictors for non-E. coli UTI and elucidate the appropriate therapeutic approach. Patients and Methods: A prospective clinical and laboratory study from 2001 through 2002 in a tertiary pediatric medical center. Patients were divided by results of the urine culture into E. coli and non-E. coli UTI groups, which were compared. Results: Of 175 episodes of culture-proved UTI, 70 (40%) were caused by non-E. coli pathogens. Non-E. coli UTI was more commonly found in children who were male (P = 0.005), who had underlying renal abnormalities (P = 0.0085) and who had received antibiotic therapy in the prior month (P = 0.0009). Non-E. coli uropathogens were often resistant to antibiotics usually recommended for initial therapy for UTI, including cephalosporins and aminoglycosides; 19% were initially treated with inappropriate empiric intravenous antibiotics (compared with 2% for E. coli UTI, P = 0.0001), with a longer hospitalization. Conclusions: Current treatment routines are often inappropriate for hospitalized children with non-E. coli UTI, which is relatively common in this population. The defined risk factors associated with non-E. coli UTIs and its antimicrobial resistance patterns should be considered to improve empiric antibiotic therapy for these infections.

Original languageEnglish
Pages (from-to)581-585
Number of pages5
JournalPediatric Infectious Disease Journal
Volume24
Issue number7
DOIs
StatePublished - Jul 2005
Externally publishedYes

Keywords

  • Antibiotic resistance
  • Children
  • Escherichia coli
  • Urinary tract infections
  • Uropathogens

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