Incidence of Escherichia coli and Its Susceptibility to Antimicrobials in Childhood Urinary Tract Infection

Chi, Hye-Mi; Kwahk, Jae-Hyok; Lee, Jun-Ho; Park, Hye-Won

J Korean Soc Pediatr Nephrol > Volume 10(1); 2006 > Article

J Korean Soc Pediatr Nephrol 2006;10(1): 18-26.

소아 요로감염에서 Escherichia coli의 빈도와 항생제 감수성에 대한 연구

지혜미, 곽재혁, 이준호, 박혜원

¹포천중문의과대학교 소아과학교실
²포천중문의과대학교 소아과학교실
³포천중문의과대학교 소아과학교실
⁴포천중문의과대학교 소아과학교실

Incidence of Escherichia coli and Its Susceptibility to Antimicrobials in Childhood Urinary Tract Infection

Hye-Mi Chi, Jae-Hyok Kwahk, Jun-Ho Lee, Hye-Won Park

¹Department of Pediatrics, College of Medicine, Pochon CHA University
²Department of Pediatrics, College of Medicine, Pochon CHA University
³Department of Pediatrics, College of Medicine, Pochon CHA University
⁴Department of Pediatrics, College of Medicine, Pochon CHA University

ABSTRACT

Purpose : Empirical antimicrobial treatment is indicated before bacteriological results are available for young children with febrile UTI to minimize renal scarring. To ensure appropriate therapy, knowledge of the prevalence of causative organisms and their susceptibility patterns to antimicrobials is mandatory. We performed a retrospective analysis investigating the local prevalence and resistance patterns of uropathogens, primarily E. coli, isolated from community-acquired UTIs.
Methods : A total of 103 positive urine cultures from children with febrile UTI collected at Bundang CHA General Hospital from February 2004 to February 2005 were analyzed. Inclusion criteria were fever higher than $37.5^{circ}C$, significant bacteriuria with single strain growth of at least 10s colony forming units/mL urine, and leukocyturia >5/HPF.
Results : E. coli(89.3%) was the leading uropathogen followed by Enterococcus spp.(3.9%) Klebsiella spp.(2.9%), Citrobctcter spp.(1.9%) and Enterobacter spp.(1.9%). E. coli strains revealed a low proportion of antimicrobial susceptibility to ampicillin(AMP; 27.2%) ampicillinsulbactam(AMS; 34.8%) and trimethoprim-sulfamethoxazole(SXT; 65.2%). Susceptibility patterns to cephalosporins were as follows; cefazolin(1st generation; 91.3%), cefoxitin(2nd; 100%), ceftriaxone(3rd; 97.8%) and cefepime(4th; 97.8%). Three E. coli isolates produced ex tended - spectrum beta-lactamase(ESBL).
Conclusion : Empirical treatment with AMP, AMS and SXT, which are commonly used in pediatric clinics, is not recommended for childhood UTI due to high incidence of resistance. The high level of susceptibility to cephalosporins makes these drugs reasonable alternatives. However the emergence of ESBL-producers, even though they are quite few, may have an impact on cephalosporin treatment in the future.

Key words: Urinary tract infection | Escherichia coli | Antimicrobial susceptibility