Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany.
Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
J Pediatr Urol. 2020 Feb;16(1):71-79. doi: 10.1016/j.jpurol.2019.10.018. Epub 2019 Oct 25.
Febrile urinary tract infections (UTIs) are common serious bacterial infections in childhood and require early diagnosis and antibacterial therapy. However, considerable uncertainty exists regarding the optimal antibacterial agent for primary treatment of pediatric UTIs. Additionally, patterns of susceptibility and resistance change over time and microbiological in vitro resistance is not necessarily associated with treatment failure. Here, we analyzed uropathogens, their resistance patterns, and response to antibacterial treatment in children with acute pyelonephritis.
We used billing codes (international classification of diseases) to identify all inpatients aged 0-18 years with febrile UTIs in a German university tertiary care center from 2009 until 2018. Microbial results were retrieved from the laboratory information system for all children, and treatment regimen and treatment response were analyzed in a subgroup of children.
We identified 907 children with acute pyelonephritis; in 590 cases (65%) an uropathogen was detected. Escherichia coli (60.8%), Enterococcus faecalis (13.2%), Klebsiella pneumoniae (7.0%), Proteus spp. (5.2%), and Pseudomonas aeruginosa (4.2%) were the most common pathogens. 353 of 436 E.coli isolates (81.0%) were susceptible or intermediate to aminopenicillin/β-lactamase-inhibitor (BLI) combinations. We examined 52 cases where E. coli was resistant to initial therapy with aminopenicillin/BLI combinations: Therapy was changed in 35 cases (67%) and left unchanged in 17 cases (33%), and we found no significant differences in C-reactive protein and leucocyte count in blood and urine between both groups after 3 days.
We present the spectrum of uropathogens and susceptibility test results in pediatric UTIs in a tertiary care center. Our findings suggest a satisfactory response to first-line therapy with aminopenicillin/BLI combinations.
发热性尿路感染（UTIs）是儿童常见的严重细菌性感染，需要早期诊断和抗菌治疗。然而，对于儿科 UTIs 的初始治疗，哪种抗菌药物最佳，目前仍存在相当大的不确定性。此外，敏感性和耐药性模式随时间而变化，微生物体外耐药性不一定与治疗失败相关。在这里，我们分析了急性肾盂肾炎患儿的尿路病原体、其耐药模式以及对抗菌治疗的反应。
我们使用计费代码（国际疾病分类）在德国大学三级护理中心确定了 2009 年至 2018 年期间所有 0-18 岁发热性 UTI 的住院患者。从实验室信息系统中检索了所有儿童的微生物学结果，并对儿童亚组进行了治疗方案和治疗反应分析。
我们确定了 907 例急性肾盂肾炎患儿；在 590 例（65%）中检测到尿路病原体。大肠埃希菌（60.8%）、粪肠球菌（13.2%）、肺炎克雷伯菌（7.0%）、变形杆菌属（5.2%）和铜绿假单胞菌（4.2%）是最常见的病原体。436 株大肠埃希菌分离株中，353 株（81.0%）对氨苄西林/β-内酰胺酶抑制剂（BLI）组合敏感或中介。我们检查了 52 例对初始氨苄西林/BLI 组合治疗耐药的大肠埃希菌：35 例（67%）改变了治疗方案，17 例（33%）未改变治疗方案，在 3 天后，两组的 C 反应蛋白和白细胞计数在血液和尿液中均无显著差异。
我们在三级护理中心展示了儿科 UTIs 的尿路病原体谱和药敏试验结果。我们的研究结果表明，一线氨苄西林/BLI 联合治疗的反应令人满意。
