Comparison of Antibiotic Resistance Patterns of Microorganisms Causing Acute Pyelonephritis in Children at 5-year Interval

Objective: Urinary tract infections (UTIs) are among the most common bacterial infections in children. Selection of empirical antibiotic therapy is based on patient characteristics and regional antibiotic resistance patterns. Antibiotic resistance driven by inappropriate antibiotic use remains currently one of the major public health concerns. The aim of this study was to compare the microbiological spectrum of pediatric acute pyelonephritis and antimicrobial resistance patterns in two time periods 5 years apart.
Method: Clinical characteristics, treatment modalities, causative uropathogens in urine cultures, antibiotic susceptibility and resistance patterns of the patients with acute acute pyelonephritis were compared between the two time periods.
Results: Group 1 consisted of 86 children (mean age 3.52 +/- 0.4 years, 32 boys) hospitalized, and treated for acute pyelonephritis between 2012-2013; Group 2 included 72 children (mean age 3.78 +/- 0.7 years, 25 boys) between 2017-2018. Escherichia coli was the most common microorganism in both groups. The most frequently used antibiotics for pyelonephritis treatment in both groups were amikacin (55% vs 51%) and ceftriaxone (33% vs 37%), gentamicin (5% vs 22%) While 77% of the children in Group 1 used prophylactic antibiotics, this rate was significantly lower with 23% in Group 2. Resistance to ampicillin, cefepime and ceftriaxone were significantly lower in Group 2. Ceftriaxone resistance which created concerns in recent years regressed from 60% to 37%.
Conclusion: Our study revealed significant reductions in rates of resistance to several antibiotics, particularly ceftriaxone within 5 year-period. Possible explanations for these results may be that aminoglycosides are preferred more frequently than ceftriaxone therapy, prophylactic treatment is limited in selected cases, and cephalosporins are not used for prophylaxis. We believe that rational empirical antibiotic selection will prevent the development of resistance in urinary tract infections.