Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
J Glob Antimicrob Resist. 2017 Jun;9:3-7. doi: 10.1016/j.jgar.2016.12.014. Epub 2017 Feb 21.
The aim of this study was to identify the antibiotic susceptibility of bacteria causing urinary tract infections (UTIs) in children in Isfahan, Iran.
Retrospective and prospective analyses were conducted on isolates from children with UTIs in a referral teaching hospital of Isfahan during 2013-2015. Findings were compared between first episode versus recurrent, nosocomial versus community-acquired, previous antibiotic use versus no previous antibiotic use, and febrile versus afebrile cases.
Among 364 patients, 68.1% had no previous UTI, 19.7% has received antibiotics prior to infection and 96.2% were infected outside the hospital. Escherichia coli was the leading cause of UTI (68.1%), followed by Enterobacter (9.3%), Klebsiella (8.8%) and other bacteria (13.7%). Most isolates were relatively highly susceptible to imipenem (79.2%), ciprofloxacin (78.0%) and nitrofurantoin (70.8%), whereas sensitivity to cefotaxime (53%), cefalexin (39.8%) and trimethoprim/sulfamethoxazole (SXT) (26.1%) was low. Resistance to imipenem, cefotaxime and cefalexin was more prevalent in recurrent cases as well as in patients consuming antibiotics prior to UTI. Resistance of nosocomial cases to nitrofurantoin and cefotaxime was higher. In addition, afebrile patients had isolates that were more resistant to imipenem, ciprofloxacin and cefotaxime. Significant cross-resistance was found between most of the studied antibiotics.
Urinary pathogens showed low susceptibility to cefalexin, SXT and cefotaxime and high susceptibility to imipenem, ciprofloxacin and nitrofurantoin. Therefore, use of imipenem and ciprofloxacin should be considered in hospitalised children with severe or complicated disease. In addition, nitrofurantoin is a good option in afebrile cases and for UTI chemoprophylaxis in this area.
本研究旨在确定伊朗伊斯法罕儿童尿路感染（UTI）的细菌抗生素敏感性。
对 2013-2015 年在伊斯法罕一所教学医院就诊的 UTI 患儿分离株进行回顾性和前瞻性分析。将首次发作与复发、医院获得性与社区获得性、使用抗生素前与未使用抗生素、发热与不发热病例进行比较。
364 例患儿中，68.1%无既往 UTI，19.7%在感染前使用过抗生素，96.2%为院外感染。大肠埃希菌是 UTI 的主要病原体（68.1%），其次为肠杆菌（9.3%）、克雷伯菌（8.8%）和其他细菌（13.7%）。大多数分离株对亚胺培南（79.2%）、环丙沙星（78.0%）和呋喃妥因（70.8%）相对高度敏感，而对头孢噻肟（53%）、头孢氨苄（39.8%）和复方磺胺甲噁唑（SXT）（26.1%）的敏感性较低。在复发和使用抗生素前发生 UTI 的患者中，亚胺培南、头孢噻肟和头孢氨苄的耐药性更为普遍。此外，医院获得性病例对呋喃妥因和头孢噻肟的耐药性更高。此外，不发热的患者的分离株对亚胺培南、环丙沙星和头孢噻肟的耐药性更高。研究的大多数抗生素之间存在显著的交叉耐药性。
尿路感染病原体对头孢氨苄、SXT 和头孢噻肟的敏感性较低，对亚胺培南、环丙沙星和呋喃妥因的敏感性较高。因此，对于严重或复杂疾病的住院患儿，应考虑使用亚胺培南和环丙沙星。此外，在该地区，对于不发热的病例和 UTI 化学预防，呋喃妥因是一个不错的选择。
