Rodríguez-Lozano Jesús, de Malet Ana, Cano María Eliecer, de la Rubia Luis, Wallmann Reinhard, Martínez-Martínez Luis, Calvo Jorge
Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2018 Aug-Sep;36(7):417-422. doi: 10.1016/j.eimc.2017.08.003. Epub 2017 Oct 7.
Cumulative susceptibility reports are a valuable tool for the empirical treatment of urinary tract infections, especially in the current context of increasing resistance rates. Our objective was to analyze the antimicrobial susceptibility of bacterial isolates in urine cultures of pediatric patients during a five-year period.
Retrospective study of urine cultures from 2011 to 2015. Identification and antimicrobial susceptibility tests were performed using the Vitek-2 system (BioMérieux) and categorized according to EUCAST criteria. Antimicrobial susceptibility data were analyzed by gender and age groups (neonates, 1 month to 5 years, 5-15 years) before being compared with data obtained from patients over the age of 15 years.
During the study period, 17164 urine cultures were processed from 7924 patients under 16 years of age. Antimicrobial susceptibility rates in these patients were: ampicillin 36.3%, amoxicillin/clavulanic acid 75.3%, cefuroxime 83.2%, co-trimoxazole 68.9%, ciprofloxacin 85.3%, fosfomycin 85.5%, nitrofurantoin 84.4% and 3rd generation cephalosporins 89-91%. Aminoglycosides (>92%) and carbapenems (95%) maintained the highest susceptibility rates. The prevalence of ESBL-producing isolates was significantly lower in children under the age of 16 years (1.5% vs. 4.1%). In patients under the age of 16 years, Escherichia coli isolates in girls were significantly more sensitive (p<0.0001) to ampicillin (41% vs. 30%) and amoxicillin/clavulanic acid (82% vs. 72%) than in boys.
The compilation of cumulative susceptibility reports disaggregated by age or gender reveals significant differences. In our setting, cefuroxime may be considered the first-line empirical treatment in pediatric patients.
累积药敏报告是经验性治疗尿路感染的重要工具，尤其是在当前耐药率不断上升的情况下。我们的目的是分析五年期间儿科患者尿培养中细菌分离株的抗菌药敏情况。
对2011年至2015年的尿培养进行回顾性研究。使用Vitek-2系统（生物梅里埃公司）进行鉴定和抗菌药敏试验，并根据欧洲抗菌药物敏感性试验委员会（EUCAST）标准进行分类。在将抗菌药敏数据与15岁以上患者的数据进行比较之前，先按性别和年龄组（新生儿、1个月至5岁、5至15岁）进行分析。
在研究期间，对7924名16岁以下患者的17164份尿培养进行了处理。这些患者的抗菌药敏率分别为：氨苄西林36.3%、阿莫西林/克拉维酸75.3%、头孢呋辛83.2%、复方新诺明68.9%、环丙沙星85.3%、磷霉素85.5%、呋喃妥因84.4%以及第三代头孢菌素89 - 91%。氨基糖苷类（>92%）和碳青霉烯类（95%）保持着最高的药敏率。16岁以下儿童中产超广谱β-内酰胺酶（ESBL）分离株的患病率显著低于16岁以上患者（1.5%对4.1%）。在16岁以下患者中，女孩的大肠埃希菌分离株对氨苄西林（41%对30%）和阿莫西林/克拉维酸（82%对72%）的敏感性显著高于男孩（p<0.0001）。
按年龄或性别分类编制的累积药敏报告显示出显著差异。在我们的研究环境中，头孢呋辛可被视为儿科患者的一线经验性治疗药物。
