Korean Journal of Pediatrics 2009;52(10):1147-1152.
Published online October 15, 2009.
Microbiological spectrum and antibiotic susceptibility pattern in more than 24-month-old children with urinary tract infection: A6-year retrospective, single center experience
Jeong Hee Ko1, Jee Hyung Lee1, Eun Jung Shim1, Do jun Cho1, Ki Sik Min1, Ki Yang Yoo1, Dae Young Lee1, Hee Jung Kang2
1Departments of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
2Departments of Laboratory Medicine, College of Medicine, Hallym University, Seoul, Korea
24개월 이상 소아에서 요로 감염의 원인균과 항생제 감수성의 양상 : 6년간 단일 기관 경험
고정희1, 이지현1, 심은정1, 조도준1, 민기식1, 유기양1, 이대형1, 강희정2
1한림대학교 의과대학 소아과학교실
2한림대학교 의과대학 진단검사의학과학교실
Correspondence: 
Dae Young Lee, Email: mdleedh@hallym.or.kr
Abstract
Purpose
: To characterize the pathogens and their antibiotic susceptibilities in more than 24-month-old children with urinary tract infection (UTI) and to study the Escherichia coli antimicrobial susceptibility trend.
Methods
: We retrospectively reviewed the record of more than 24-month-old children with UTI between January 2003 and December 2008. Positive results for 1 bacterial species with a colony count of ≥105 CFU/mL was considered statistically significant. We analyzed uropathogens and their antibiotic susceptibilities. To investigate E. coli antibiotic susceptibility trend, we compared 2 study periods (group A: 2003-2005 versus group B: 2006-2008) using the chi-square test for trend.
Results
: In all, 63 bacterial isolates were identified in children with febrile UTI. The most common pathogen was E. coli (77.8%). There was no difference in the resistance patterns of uropathogens during the 2 study periods (P>0.05). Antibiotic susceptibility of the E. coli isolates to aztreonam, cefotetan, cefotaxime, ceftriaxone, cefepime, amikacin, and imipenem was >90% to trimethoprim/sulfamethoxazol, 49% and to ampicillin and ampicillin/sulbactam, 20-25%. Over the 2 study period, the E. coli susceptibilities to most antibiotics did not change: the susceptibility to cefuroxime increased from 74.1% to 95.5% (P=0.046) and that to ciprofloxacin increased from 59.3% to 86.4% (P=0.039).
Conclusion
: Empirical treatment with trimethoprim/sulfamethoxazole, ampicillin, and ampicillin/sulbactam alone appeared to be insufficient in childhood UTI because of the high resistance of E. coli and other gram-negative uropathogens. Antibiotics for empirical therapy should be selected based on the sensitivity and resistance pattern of uropathogens found in a particular region.
Key Words: Urinary tract infection, Children, Antibiotic resistance


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