OBJECTIVEThis study investigated the pathogen distribution and resistance patterns in childhood urinary tract infection in order to provide references for optimal use of antibiotics in the treatment of this disorder.

METHODSThe clinical data of 152 children with community acquired urinary tract infection (urinary culture positive) between December 2001 and December 2004 were studied retrospectively. The bacterial pathogens of urinary tract infection and antimicrobial resistance were analyzed.

RESULTSGram-negative bacilli was predominant pathogenic bacteria, accounting for 79.0% of the cases, and Escherichia coli (E. coli) was most commonly found (56.2%). Gram-positive cocci accounted for 18.4%, including 15.1% of Enterococcus faecalis. Fungi was rarely seen, accounting for only 2.6%. E. coli had a resistance rate of more than 50% to ampicillin, amoxicillin/clavulate, co-trimoxazole, cefradine, and fosomycin, but a very low resistance rate (< 4%) to 3rd generation cefalosporin, nitrofurantoi, azactom and amikacin. Enterococcus faecalis had a low resistance rate (< 20%) to ampicillin, vancomycin, penicillin, and nitrofurantoin.

CONCLUSIONSE. coli is the major pathogen in community acquired pediatric urinary tract infection, and Enterococcus has been become another important pathogen. Selection of antibiotics for the treatment of this disorder should base on drug-sensitive test results.

Adolescent ; Bacteria ; drug effects ; isolation & purification ; Child ; Child, Preschool ; Community-Acquired Infections ; drug therapy ; microbiology ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Male ; Urinary Tract Infections ; drug therapy ; microbiology

OBJECTIVETo assess the bacterial profile and pattern of antibiotic resistance of urinary tract infections (UTIs) pathogens and to determine its clinical impact on management.

METHODSMidstream urine samples were submitted for culture from 1998 to 2002, and 798 isolates were obtained for antimicrobial susceptibility testing including amikacin (AMK), ampicillin (AMP), cefzolin (CFZ), cefuroxime (CXM), ceftriaxone (CRO), ceftaxime (CTX), ceftazidime (CAZ), nalidixoc acid (NAL), ciprofloxacin (CIP), trimethoprim/sulfamethoxazole (SXT), nitrofurantoin (NIT) for Gram-negative bacteria and oxcillin (OXA), ampicillin (AMP), cefzolin (CFZ), ciprofloxacin (CIP), gentamicin (Gen), vancomycin (VAN), trimethoprim/sulfamethoxazole (SXT), nitrofurantoin (NIT) for Gram-positive cocci. beta-lactamases and ESBLs were tested when needed.

RESULTSEnterobacteriaceae was the most frequently isolated pathogen. Among all the isolates, Escherichia coli accounted for 66.0%, followed by Enterococcus (6.5%), Klebsiella spp. (6.0%), Staphylococcus (5.4%). High resistance rates to CIP (56.0%), SXT (67.0%) and AMP (78.9%) were observed among the E. coli. CIP-resistant E. coli strains are being isolated with increasing frequency. From 1998 to 2002 the incidence of CIP-resistant increased steadily from 46.6% to 59.4%. A higher resistance rate to NAL was apparent. In contrast, NIT displayed a resistance rate of 8.9%, and AMK 4.9%. The ESBLs positive rate was 12.9% among the E. coli and 33.3% among the Klebsiella spp. respectively. A high resistance rate to CIP was also observed among the Staphylococcus (38.1%), Enterococcus (61.5%) and Streptococcus (85.0%), and the beta-lactamases positive rate was 95.2% among the Staphylococcus, but a lower resistance rate to NIT among Staphylococcus (2.4%) and Enterococcus (11.5%).

CONCLUSIONSResistance rates among common uropathogens continue to evolve and appear to be increasing to many commonly used agents especially to quinolones. Continued surveillance of resistance rates among uropathogens is needed to ensure appropriate recommendations for the treatment of the infections. Currently, the most appropriate agent for the empirical management of UTIs seems to be nitrofurantoin.

Ciprofloxacin ; therapeutic use ; Drug Resistance, Bacterial ; Humans ; Microbial Sensitivity Tests ; Nitrofurantoin ; therapeutic use ; Urinary Tract Infections ; drug therapy ; microbiology

No abstract available.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacteria/metabolism ; Catheter-Related Infections/diagnosis/drug therapy/*microbiology ; Color ; Equipment Design ; Escherichia coli Infections/diagnosis/drug therapy/*microbiology ; Female ; Humans ; Intestines/*microbiology ; Pigments, Biological/metabolism ; Treatment Outcome ; Tryptophan/metabolism ; Urinary Bladder Neoplasms/surgery ; Urinary Catheterization/adverse effects/*instrumentation ; *Urinary Catheters ; *Urinary Diversion ; Urinary Tract Infections/diagnosis/drug therapy/*microbiology ; Urine/chemistry/microbiology

INTRODUCTIONKlebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint.

CLINICAL PICTUREThe patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of the ankle. On admission, he was in septic shock. Investigations suggested an infective cause, as evidenced by raised total white cell count and pyuria. K. pneumoniae was cultured from both urine and ankle synovial fluid. Imaging confirmed multiple liver and prostatic abscesses, as well as osteomyelitis of the foot bones adjacent to the ankle.

TREATMENTTreatment in this case included surgical drainage of the affected joint and surrounding soft tissue structures, in addition to a 6-week course of systemic antibiotics.

OUTCOMEThe patient had good clinical response following treatment. In addition, we noted a normalisation of his laboratory parameters and resolution of the intraabdominal and pelvic abscesses.

CONCLUSIONThis case emphasises the importance of timely and accurate diagnosis followed by appropriate treatment in disseminated K. pneumoniae infection to prevent significant morbidity and mortality.

Aged ; Ankle Joint ; microbiology ; surgery ; Anti-Bacterial Agents ; therapeutic use ; Arthritis, Infectious ; diagnosis ; microbiology ; therapy ; Combined Modality Therapy ; Drainage ; Foot Bones ; microbiology ; Humans ; Klebsiella Infections ; diagnosis ; therapy ; Klebsiella pneumoniae ; Liver Abscess ; microbiology ; Magnetic Resonance Imaging ; Male ; Osteomyelitis ; drug therapy ; epidemiology ; microbiology ; surgery ; Prostatic Diseases ; microbiology ; Synovial Fluid ; microbiology ; Tomography, X-Ray Computed ; Urinary Tract Infections ; drug therapy ; microbiology

OBJECTIVETo investigate the distribution and antibiotic resistance of pathogens isolated from children with complicated urinary tract infection.

METHODSA retrospective analysis was performed on the distribution and antibiotic resistance of pathogens isolated from 181 children with complicated urinary tract infection (positive urine culture). The antibiotic resistance of common pathogens was determined by the antimicrobial susceptibility test.

RESULTSGram-negative bacilli were the main pathogens (63.5%), and involved Escherichia coli (E.coli) of 42.0%. Gram-positive cocci accounted for 32.1%, and involved enterococci faecalis of 15.5%. Fungi infection was found in 4.4% of children. The resistance rate of E.coli to ampicillin was the highest (89.4%), but the rate decreased significantly by adding amoxicillin/clavulanic acid (34.2%). E.coli had a high resistance rate to cephazolin, ceftriaxone and cafalotin (>50%), but the resistance rate of E.coli to cefoperazone/sulbouam was significantly lower than other cephalosporins (P<0.01). E.coli was sensitive to imipenem and displayed a lower resistance rate to furadantin (<10%). The resistance rate of enterococci faecalis to rifampicin was high (78.3%), but was low to furadantin, vancomycin and linezolid (<10%). The multiresistant strains accounted for 77.4% of gram-negative bacilli.

CONCLUSIONSE.coli is the major pathogen in children with complicated urinary tract infection, and the enterococci-caused urinary tract infection has been increasing. These pathogens have a high antibiotic resistance, and most of them are multiresistant. Antimicrobial therapy should be based on the results of urine culture and antimicrobial susceptibility test.

Adolescent ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Enterococcus ; drug effects ; Escherichia coli ; drug effects ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Urinary Tract Infections ; drug therapy ; microbiology

PURPOSE: Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)]. RESULTS: Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0+/-8.2 months) than in boys (5.8+/-4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean+/-SD age at diagnosis of VUR in patients with breakthrough infection (1.14+/-3.14) was significantly younger than in those without breakthrough infection (5.05+/-3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028). CONCLUSION: Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
Anti-Bacterial Agents/*therapeutic use ; Female ; Humans ; Infant ; Male ; Retrospective Studies ; Urinary Tract Infections/*drug therapy/etiology ; Vesico-Ureteral Reflux/complications/*drug therapy/*microbiology

Adolescent ; Bacteria ; drug effects ; isolation & purification ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Urinary Tract Infections ; drug therapy ; microbiology

Ampicillin ; therapeutic use ; Anti-Infective Agents ; therapeutic use ; Enterobacteriaceae ; drug effects ; pathogenicity ; Enterobacteriaceae Infections ; drug therapy ; microbiology ; Female ; Hospitals, Military ; Humans ; Male ; Sulbactam ; therapeutic use ; Urinary Tract Infections ; drug therapy ; microbiology

OBJECTIVETo study the clinical features, distribution of pathogens, drug susceptibility, and treatment effectiveness in neonates with urinary tract infection (UTI) and admitted to the neonatal intensive care unit (NICU).

METHODSThe clinical data of 229 neonates who developed UTI during their stay in the NICU were retrospectively studied.

RESULTSThe main clinical manifestations of these children included fever/irregular body temperature, refusing to milk feeding, jaundice, vomiting, diarrhea, poor weight gain, and lethargy. The top three pathogens were Escherichia coli, Enterococcus feces, and Klebsiella pneumoniae. Escherichia coli and Klebsiella pneumoniae were highly resistant to ampicillin and most cephalosporins (≥ 85%), and were highly sensitive to imipenem (100%), meropenem (100%), cefoperazone/sulbactam and piperacillin/tazobactam (>90%). Enterococcus feces were highly resistant to penicillin (100%), rifampicin (84%) and gentamicin (79%), but were sensitive to vancomycin.

CONCLUSIONSThe clinical manifestations of neonatal UTI are often atypical and manifested as systemic symptoms. The main pathogenic bacterium is Escherichia coli, and the isolation rate of enterococci can also be high. Most pathogenic bacteria are resistant to penicillin and cephalosporins, and therefore decision-making on drug administration must be based on the results of drug sensitivity tests.

Drug Resistance, Bacterial ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Microbial Sensitivity Tests ; Retrospective Studies ; Urinary Tract Infections ; drug therapy ; microbiology

OBJECTIVE: To investigate the bacterial distribution and resistance to antibiotics in culture-positive urine, and to provide reference for rational use of antibiotics in clinical practice. METHODS: Distribution and antibiotic resistance to pathogens in 658 culture-positive patients from Jan. 1, 2007 to Dec. 31, 2008 were analyzed. RESULTS: (1)Pathogenic strains from the 658 patients were collected from the urine specimen in the survey, which included Gram-negative bacilli (70.82%), Gram-positive cocci (26.14%) and fungi (3.04%). The distribution rate of Escherichia coli declined from 68.91% in 2008 to 63.43% in 2007 (P>0.05), and Enterococcus rose from 3.37% to 7.67% (P>0.05), but the difference was not significant. The proportion of Gram-negative bacilli (especially the E.coli) from patients in the Emergency Department and Out-patient Department was higher than that from in-patients, and the proportion of K. pneumonia and Gram-positive bacteria was lower than in-patients, both with significant differences (P<0.05). (2) The resistance rate of E. coli and K. pneumonia to quinolones was 28.57%-56.25%, and the resistance rate to 3rd generation cephalosporin was 38.78%-65.78%, respectively. The resistance rate of Gram-positive cocci to quinolones and 3rd generation cephalosporin was both higher than 50%, and was 11.05% to Vancomycin. CONCLUSION Gram-negative bacilli such as E. coli and K. pneumonia are predominant organism in the urinary tract infections, but proportion of Gram-positive bacteria has increased in recent years. Attention needs to be paid to the overall and severe bacterial resistance in the urinary tract infections and rational use of antibiotics.
Adult ; Anti-Infective Agents, Urinary ; pharmacology ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; isolation & purification ; Female ; Gram-Negative Bacteria ; isolation & purification ; Gram-Positive Bacteria ; isolation & purification ; Humans ; Male ; Retrospective Studies ; Urinary Tract Infections ; drug therapy ; microbiology ; Urine ; microbiology