Esposito Susanna, Maglietta Giuseppe, Di Costanzo Margherita, Ceccoli Martina, Vergine Gianluca, La Scola Claudio, Malaventura Cristina, Falcioni Alice, Iacono Alessandra, Crisafi Antonella, Iughetti Lorenzo, Conte Maria Luisa, Pierantoni Luca, Gatti Claudia, Caminiti Caterina, Biasucci Giacomo
Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
Research and Innovation Unit, University Hospital, 43126 Parma, Italy.
Antibiotics (Basel). 2021 Oct 4;10(10):1207. doi: 10.3390/antibiotics10101207.
The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between 1 January 2012, and 30 June 2020, in Emilia-Romagna, Italy, were analysed. was the most frequently detected pathogen (75.6%), followed by (6.9%) and (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.
抗生素耐药性的发展和传播是一个日益重要的全球公共卫生问题，即使在小儿尿路感染（UTI）中也是如此。鉴于数据的变异性，有必要开展监测研究，以确定特定地理区域的抗生素耐药性流行情况，从而优化治疗管理。在这项观察性、回顾性、多中心研究中，分析了2012年1月1日至2020年6月30日期间在意大利艾米利亚-罗马涅因UTI住院的1801例儿科患者的病历。大肠埃希菌是最常检测到的病原体（75.6%），其次是肺炎克雷伯菌（6.9%）和粪肠球菌（2.5%）。总体而言，840例（46.7%）病例是由耐抗菌药物的尿路病原体引起的：83例（4.7%）产超广谱β-内酰胺酶（ESBL），119例（6.7%）多重耐药（MDR），4例（0.2%）广泛耐药（XDR）细菌。经验性抗生素治疗在172例（9.6%）中失败。存在ESBL或MDR/XDR尿路病原体、复发性UTI病史、前30天内使用过抗生素治疗以及使用阿莫西林或阿莫西林/克拉维酸进行经验性治疗与治疗失败显著相关，而使用第三代头孢菌素进行一线治疗与预防不良结局相关。总之，尿路病原体对常用抗生素耐药性的增加需要持续监测，抗生素选择的建议需要更新。在我们的流行病学背景下，阿莫西林/克拉维酸似乎不再是因UTI住院儿童的合适一线治疗药物，而第三代头孢菌素仍然有用。为了进一步限制耐药性的出现，必须尽一切努力减少和合理使用抗生素。
