Children's Hospital of Philadelphia, Division of Infectious Diseases, 3615 Civic Center Blvd, ARC 1202, Philadelphia, PA 19104, USA.
Pediatrics. 2010 Apr;125(4):664-72. doi: 10.1542/peds.2009-1527. Epub 2010 Mar 1.
The aim of this study was to evaluate the impact of previous antimicrobial exposure on the development of antimicrobial resistance in children with their first urinary tract infection (UTI).
We conducted a retrospective cohort study of children aged 6 months to 6 years and received their first diagnosis of UTI in a network of 27 outpatient pediatric practices between July 1, 2001, and May 31, 2006. We examined the relationship between antimicrobial resistance in UTI isolates and exposure to specific antimicrobial agents (amoxicillin, amoxicillin-clavulanate, cefdinir, trimethoprim-sulfamethoxazole, and azithromycin) in the previous 120 days. We developed multivariable logistic regression models for resistance to ampicillin, amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, and first-generation and third-generation cephalosporins, adjusting for potential confounders such as age, number of siblings, recent hospitalizations, and child care exposure.
Of the 533 children who had a first UTI, 8%, 14%, and 21% were exposed to antimicrobial agents within 30, 60, and 120 days before the UTI, respectively. Amoxicillin exposure within 30 days (odds ratio [OR]: 3.6 [95% confidence interval (CI): 1.6-8.2]) and 31 to 60 days (OR: 2.8 [95% CI: 1.0-7.5]) before UTI both were associated with ampicillin resistance. Exposure to amoxicillin >60 days before the UTI was not associated with ampicillin resistance. Amoxicillin exposure within 30 days of UTI was also associated with amoxicillin-clavulanate resistance (OR: 3.9 [95% CI: 1.8-8.7]). No association between exposure to other antimicrobial agents and resistance to any of the antimicrobial agents was seen.
Recent antimicrobial exposure is associated with antimicrobial-resistant UTIs among pediatric outpatients, and the magnitude of this association decreases with time since exposure. Judicious antimicrobial prescribers should consider this association when selecting empiric antimicrobial agents for a new UTI and should use strategies to reduce unnecessary antimicrobial use to avoid development of resistant bacteria.
本研究旨在评估儿童首次尿路感染 (UTI) 前抗菌药物暴露对其抗菌药物耐药性发展的影响。
我们进行了一项回顾性队列研究，纳入了 2001 年 7 月 1 日至 2006 年 5 月 31 日期间在 27 家门诊儿科诊所就诊、年龄在 6 个月至 6 岁之间并首次诊断为 UTI 的儿童。我们研究了 UTI 分离株的抗菌药物耐药性与前 120 天内暴露于特定抗菌药物（阿莫西林、阿莫西林-克拉维酸、头孢地尼、复方磺胺甲噁唑和阿奇霉素）之间的关系。我们为阿莫西林、阿莫西林-克拉维酸、复方磺胺甲噁唑、第一代和第三代头孢菌素的耐药性开发了多变量逻辑回归模型，调整了年龄、兄弟姐妹数量、近期住院和儿童保育暴露等潜在混杂因素。
在 533 名首次发生 UTI 的儿童中，分别有 8%、14%和 21%在 UTI 前 30、60 和 120 天内接受过抗菌药物治疗。在 UTI 前 30 天（比值比 [OR]：3.6 [95%置信区间 (CI)：1.6-8.2]）和 31-60 天（OR：2.8 [95% CI：1.0-7.5]）内暴露于阿莫西林均与氨苄西林耐药相关。在 UTI 前 60 天以上暴露于阿莫西林与氨苄西林耐药无关。在 UTI 前 30 天内暴露于阿莫西林也与阿莫西林-克拉维酸耐药相关（OR：3.9 [95% CI：1.8-8.7]）。其他抗菌药物暴露与任何抗菌药物的耐药性之间均无关联。
儿科门诊中近期抗菌药物暴露与抗菌药物耐药性 UTI 相关，且这种关联的程度随暴露时间的推移而降低。经验性抗菌药物治疗新 UTI 时，明智的抗菌药物处方者应考虑这种关联，并应采取策略减少不必要的抗菌药物使用，以避免耐药菌的产生。
