Predictors of Antimicrobial Resistance among Pathogens Causing Urinary Tract Infection in Children

J Pediatr. 2016 Apr;171:116-21. doi: 10.1016/j.jpeds.2015.12.044. Epub 2016 Jan 13.

Abstract

Objective: To determine which children with urinary tract infection are likely to have pathogens resistant to narrow-spectrum antimicrobials.

Study design: Children, 2-71 months of age (n = 769) enrolled in the Randomized Intervention for Children with Vesicoureteral Reflux or Careful Urinary Tract Infection Evaluation studies were included. We used logistic regression models to test the associations between demographic and clinical characteristics and resistance to narrow-spectrum antimicrobials.

Results: Of the included patients, 91% were female and 76% had vesicoureteral reflux. The risk of resistance to narrow-spectrum antibiotics in uncircumcised males was approximately 3 times that of females (OR 3.1; 95% CI 1.4-6.7); in children with bladder bowel dysfunction, the risk was 2 times that of children with normal function (OR 2.2; 95% CI 1.2-4.1). Children who had received 1 course of antibiotics during the past 6 months also had higher odds of harboring resistant organisms (OR 1.6; 95% CI 1.1-2.3). Hispanic children had higher odds of harboring pathogens resistant to some narrow-spectrum antimicrobials.

Conclusions: Uncircumcised males, Hispanic children, children with bladder bowel dysfunction, and children who received 1 course of antibiotics in the past 6 months were more likely to have a urinary tract infection caused by pathogens resistant to 1 or more narrow-spectrum antimicrobials.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Amoxicillin / pharmacology
  • Anti-Infective Agents / pharmacology*
  • Cephalosporins / pharmacology
  • Child
  • Child, Preschool
  • Drug Resistance, Bacterial*
  • Escherichia coli
  • Female
  • Humans
  • Infant
  • Intestinal Diseases / drug therapy
  • Intestinal Diseases / epidemiology
  • Intestinal Diseases / microbiology
  • Male
  • Nitrofurantoin / pharmacology
  • Odds Ratio
  • Regression Analysis
  • Sulfamethoxazole / pharmacology
  • Trimethoprim / pharmacology
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / microbiology*
  • Vesico-Ureteral Reflux / drug therapy
  • Vesico-Ureteral Reflux / epidemiology
  • Vesico-Ureteral Reflux / microbiology

Substances

  • Anti-Infective Agents
  • Cephalosporins
  • Amoxicillin
  • Nitrofurantoin
  • Trimethoprim
  • Sulfamethoxazole