Skip to main content
SpringerLink
Log in

Urinary tract infection in small outpatient children: the influence of age and gender on resistance to oral antimicrobials

  • Original Article
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Urinary tract infection (UTI) is a common bacterial disease in small children in which treatment with antimicrobials is used. The worldwide increase of bacterial resistance to these drugs is threatening the efficacy of such treatment and may increase the risk for long-term damage. The aim of this retrospective study was to analyse the development of resistance to oral antimicrobials over a 10-year period in an unselected outpatient population of small children with first-time UTI. The patient material included 494 boys and 512 girls below 2 years of age with community acquired symptomatic UTI. Escherichia coli bacteria were isolated in 96 % of girls and 89 % of boys (p < 0.0001). The overall resistance of E. coli was 14 % to trimethoprim and below 1 % to cefadroxil and nitrofurantoin. Over the 10-year period, the trimethoprim resistance of E. coli increased from 5 to 17 % but remained unchanged to cefadroxil and nitrofurantoin. E. coli resistance to trimethoprim was related to age: 11 % below and 19 % above 9 months (p < 0.01). The increase in resistance over time and with age was found only in girls. Conclusion: The increasing resistance of E. coli to trimethoprim makes this drug less suitable for empiric treatment of UTI. Young children with UTI seem predisposed to early development of resistance. Therefore, surveillance of resistance to antimicrobials with special regard to age and gender is recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CFU:

Colony forming units

CRP:

C-reactive protein

ESBL:

Extended spectrum betalactamase

MUCG:

Micturating urethrocystography

RSQC:

Swedish Annual Resistance Surveillance and Quality Control

UTI:

Urinary tract infection

VUR:

Vesicoureteral reflux

References

  1. Abelson Storby K, Osterlund A, Kahlmeter G (2004) Antimicrobial resistance in Escherichia coli in urine samples from children and adults: a 12 year analysis. Acta Paediatr 93:487–491

    Google Scholar 

  2. Allen UD, MacDonald N, Fuite L, Chan F, Stephens D (1999) Risk factors for resistance to “first-line” antimicrobials among urinary tract isolates of Escherichia coli in children. CMAJ 160:1436–1440

    CAS  PubMed Central  PubMed  Google Scholar 

  3. Bean DC, Krahe D, Wareham DW (2008) Antimicrobial resistance in community and nosocomial Escherichia coli urinary tract isolates, London 2005–2006. Ann Clin Microbiol Antimicrob 7:13. doi:10.1186/1476-0711-7-13

    Article  PubMed Central  PubMed  Google Scholar 

  4. Birgy A, Cohen R, Levy C, Bidet P, Courroux C, Benani M, Thollot F, Bingen E (2012) Community faecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in French children. BMC Infect Dis 12:315. doi:10.1186/1471-2334-12-315

    Article  PubMed Central  PubMed  Google Scholar 

  5. Cullen IM, Manecksha RP, McCullagh E, Ahmad S, O’Kelly F, Flynn RJ, McDermott T, Murphy P, Grainger R, Fennell JP, Thornhill JA (2012) The changing pattern of antimicrobial resistance within 42,033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999–2009. BJU Int 109:1198–1206. doi:10.1111/j.1464-410X.2011.10528.x

    Article  PubMed  Google Scholar 

  6. Edlin R, Shapiro D, Hersh A, Copp H (2013) Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol 190:222–227, doi: 0.1016/j.juro.2013.01.069

    Article  CAS  PubMed  Google Scholar 

  7. Gaspari RJ, Dickson E, Karlowsky J, Doern G (2005) Antibiotic resistance trends in paediatric uropathogens. Int J Antimicrob Agents 26:267–271

    Article  CAS  PubMed  Google Scholar 

  8. Gupta K, Scholes D, Stamm WE (1999) Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA 281:736–738

    Article  CAS  PubMed  Google Scholar 

  9. Hakansson A, Petersson C (1992) Drug consumption during the first 18 months of life of infants from smoking and non-smoking families. Br J Gen Pract 42:362–365

    Google Scholar 

  10. Hanson LA (1976) Esch. coli infections in childhood. Significance of bacterial virulence and immune defence. Arch Dis Child 51:737–743

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Helldal L, Karami N, Floren K, Welinder-Olsson C, Moore ER, Ahren C (2013) Shift of CTX-M genotypes has determined the increased prevalence of extended-spectrum beta-lactamase-producing Escherichia coli in south-western Sweden. Clin Microbiol Infect 19:E87–E90. doi:10.1111/1469-0691.12086

    Article  CAS  PubMed  Google Scholar 

  12. Hellerstein S (1998) Urinary tract infections in children: why they occur and how to prevent them. Am Fam Physician 57(2440–6):2452–2454

    Google Scholar 

  13. Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, Kearney DH, Reynolds EA, Ruley J, Janosky JE (1999) Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 104:79–86

    Article  CAS  PubMed  Google Scholar 

  14. Jacobson SH, Eklof O, Eriksson CG, Lins LE, Tidgren B, Winberg J (1989) Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ 299:703–706

    Google Scholar 

  15. Jantunen ME, Siitonen A, Ala-Houhala M, Ashorn P, Föhr A, Koskimies O, Wikström S, Saxén H (2001) Predictive factors associated with significant urinary tract abnormalities in infants with pyelonephritis. Pediatr Infect Dis J 20:597–601

    Article  CAS  PubMed  Google Scholar 

  16. Jodal U, Winberg J (1987) Management of children with unobstructed urinary tract infection. Pediatr Nephrol 1:647–656

    Article  CAS  PubMed  Google Scholar 

  17. Kanellopoulos TA, Salakos C, Spiliopoulou I, Ellina A, Nikolakopoulou NM, Papanastasiou DA (2006) First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol 21:1131–1137

    Article  PubMed  Google Scholar 

  18. Lagacé-Wiens PR, Simner PJ, Forward KR, Tailor F, Adam HJ, Decorby M, Karlowsky J, Hoban DJ, Zhanel GG (2011) Canadian Antimicrobial Resistance Alliance (CARA). Analysis of 3789 in. and outpatient Escherichia coli isolates from across Canada—results of the CANWARD 2007-2009 study. Diagn Microbiol Infect Dis 69(3):314–319. doi:10.1016/j.diagmicrobio.2010.10.027

    Article  PubMed  Google Scholar 

  19. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE (1985) International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109

    Article  CAS  PubMed  Google Scholar 

  20. Marild S, Jodal U (1998) Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 87:549–552

    Google Scholar 

  21. Martinell J, Jodal U, Lidin-Janson G (1990) Pregnancies in women with and without renal scarring after urinary infections in childhood. BMJ 300:840–844

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. McGregor JC, Elman MR, Bearden DT, Smith DH (2013) Sex- and age-specific trends in antibiotic resistance patterns of Escherichia coli urinary isolates from outpatients. BMC Fam Pract 14:25. doi:10.1186/1471-2296-14-25

    Article  PubMed Central  PubMed  Google Scholar 

  23. Mölstad S, Cars O, Struwe J (2008) Strama—a Swedish working model for containment of antibiotic resistance. Euro Surveill 13(46). doi:http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19041

  24. Mölstad S, Erntell M, Hanberger H, Melander E, Norman C, Skoog G, Lundborg CS, Söderström A, Torell E, Cars O (2008) Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme. Lancet Infect Dis 8:125–132. doi:10.1016/S1473-3099(08)70017-3

    Article  PubMed  Google Scholar 

  25. Patzer L, Seeman T, Luck C, Wuhl E, Janda J, Misselwitz J (2003) Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142:117–122

    Article  PubMed  Google Scholar 

  26. Prelog M, Schiefecker D, Fille M, Wurzner R, Brunner A, Zimmerhackl LB (2008) Febrile urinary tract infection in children: ampicillin and trimethoprim insufficient as empirical mono-therapy. Pediatr Nephrol 23:597–602. doi:10.1007/s00467-007-0701-1

    Article  PubMed  Google Scholar 

  27. Ragnarsdottir B, Svanborg C (2012) Susceptibility to acute pyelonephritis or asymptomatic bacteriuria: host-pathogen interaction in urinary tract infections. Pediatr Nephrol 27:2017–2029. doi:10.1007/s00467-011-2089-1 27:2017-29

    Article  PubMed  Google Scholar 

  28. Ransley PG, Risdon RA (1981) Reflux nephropathy: effects of antimicrobial therapy on the evolution of the early pyelonephritic scar. Kidney Int 20:733–742

    Article  CAS  PubMed  Google Scholar 

  29. Swedish Reference Group of Antibiotics (1997) Antimicrobial susceptibility testing in Sweden. Scand J Infect Dis Suppl 105:5–31

    Google Scholar 

  30. Swedish Institute for Infectious Disease Control. Smittskyddsinstitutet. http://www.smittskyddsinstitutet.se/publikationer/arsrapporter-och-verksamhetsberattelser/swedres/swedres-2003/. Accessed 19 Nov 2013

  31. Swedish Institute for Infectious Disease Control. Smittskyddsinstitutet. http://www.smittskyddsinstitutet.se/publikationer/arsrapporter-och-verksamhetsberattelser/swedres/swedresswarm-2012/. Accessed 19 Nov 2013

  32. Yüksel S, Oztürk B, Kavaz A, Ozçakar ZB, Acar B, Güriz H, Aysev D, Ekim M, Yalçinkaya F (2006) Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract. Int J Antimicrob Agents 28:413–416

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by grants from Frimurare-Barnhusdirektionen, Göteborg and the Research Fund at Skaraborgs Sjukhus.

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Pediatric Uronephrologic Center, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, 416 85, Göteborg, Sweden

    Svante Swerkersson, Ulf Jodal & Sverker Hansson

  2. Department of Clinical Bacteriology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden

    Christina Åhrén

  3. STRAMA, The Swedish Strategic Programme against Antibiotic Resistance, Region of Västra Götaland, Göteborg, Sweden

    Christina Åhrén

Authors
  1. Svante Swerkersson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulf Jodal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christina Åhrén
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sverker Hansson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Svante Swerkersson.

Additional information

Communicated by David Nadal

Rights and permissions

Reprints and permissions

About this article

Cite this article

Swerkersson, S., Jodal, U., Åhrén, C. et al. Urinary tract infection in small outpatient children: the influence of age and gender on resistance to oral antimicrobials. Eur J Pediatr 173, 1075–1081 (2014). https://doi.org/10.1007/s00431-014-2289-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-014-2289-3

Keywords

Search

Navigation