School of Medicine, University of Split, Split, Croatia.
Med Sci Monit. 2011 Jul;17(7):CR355-61. doi: 10.12659/msm.881845.
We assessed prevalence and resistance of uropathogens on antimicrobial agents (AA) from urine cultures (UC) in children hospitalized with urinary tract infections (UTI) at University Hospital in Split.
MATERIAL/METHODS: During the 7-year period, children hospitalized only once with UTI alone were compared to those repeatedly hospitalized, and who received long-term antimicrobial prophylaxis (LTAP), as well as those with associated anomalies of the urinary system (US).
E. coli was the most frequent isolate (67.7%) with resistance to ampicillin by 69.5%, amoxicillin/clavulonic acid by 3.5%, cephalexin by 6.6%, trimethoprim/sulfamethoxazole (TMP-SMX) by 27.5%, and nitrofurantoin by 0.4%. For other uropathogens, AA resistance rates were the following: 64.3%, 5.8%, 10.5%, 21.3%, and 7.9%. The high or increasing resistance to TMP-SMX is characterized by all uropathogens. Patients with anomalies of US showed a lower prevalence of E. coli and Enterococcus sp., but a higher prevalence of Pseudomonas sp., ESBL-producing E. coli and Klebsiella sp. than those without US anomalies. Repeatedly hospitalized patients showed a lower prevalence of E. coli, but a higher prevalence of Pseudomonas sp. and Klebsiella sp. than patients hospitalized only once. Both groups displayed significantly less resistance of Enterococcus sp. In patients receiving LTAP before hospitalization, E. coli was significantly more resistant to ampicillin, amoxicillin/clavulonic acid and TMP/SMX than in those without LTAP.
Based on our results, we recommend excluding ampicillin altogether, and reconsideration of further use of TMP-SMX, as well as use of nitrofurantoin, cephalexin and amoxicillin/clavulonic acid for LTAP in our region.
我们评估了斯普利特大学医院住院的尿路感染（UTI）患儿尿液培养（UC）中尿病原体对抗菌药物（AA）的流行率和耐药性。
材料/方法：在 7 年期间，我们将仅因 UTI 住院一次的患儿与多次住院、接受长期抗菌预防治疗（LTAP）以及伴有泌尿系统（US）异常的患儿进行了比较。
大肠埃希菌是最常见的分离株（67.7%），对氨苄西林的耐药率为 69.5%，对阿莫西林/克拉维酸的耐药率为 3.5%，对头孢氨苄的耐药率为 6.6%，对复方磺胺甲噁唑（TMP-SMX）的耐药率为 27.5%，对呋喃妥因的耐药率为 0.4%。对于其他尿病原体，AA 耐药率分别为：64.3%、5.8%、10.5%、21.3%和 7.9%。所有尿病原体均表现出对 TMP-SMX 的高耐药率或耐药率不断增加。伴有 US 异常的患者，大肠埃希菌和肠球菌的检出率较低，但铜绿假单胞菌、产 ESBL 大肠埃希菌和克雷伯菌的检出率较高。与无 US 异常的患者相比，多次住院的患者大肠埃希菌的检出率较低，但铜绿假单胞菌和克雷伯菌的检出率较高。两组肠球菌的耐药率均显著降低。在住院前接受 LTAP 的患者中，大肠埃希菌对氨苄西林、阿莫西林/克拉维酸和 TMP-SMX 的耐药率明显高于未接受 LTAP 的患者。
根据我们的结果，我们建议在本地区完全排除氨苄西林，重新考虑进一步使用 TMP-SMX，以及使用硝基呋喃妥因、头孢氨苄和阿莫西林/克拉维酸作为 LTAP。
