Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group

Eur J Pediatr. 2015 Jun;174(6):783-90. doi: 10.1007/s00431-014-2459-3. Epub 2014 Nov 28.

Abstract

Knowledge of the distribution spectrum of causative organisms and their resistance patterns has become a core requirement for the rational and effective management of urinary tract infections. In the context of a prospective trial on the use of antibiotic prophylaxis in infants with underling kidney malformations, we conducted an online survey among paediatric nephrologists on positive urine cultures (July 2010-June 2012) from both hospitalized and non-hospitalized infants under 24 months of age. We collected 4745 urine cultures (UCs) at 18 units in 10 European countries. Escherichia coli was the most frequent bacterium isolated from UCs; however, in 10/16 hospitals and in 6/15 community settings, E. coli was isolated in less than 50% of the total positive UCs. Other bacterial strains were Klebsiella, Enterococcus, Proteus and Pseudomonas not only from hospital settings. E. coli showed a high resistance to amoxicillin and trimethoprim and variable to cephalosporin. Nitrofurantoin had a good rate of efficacy, with 11/16 hospitals and 11/14 community settings reporting a resistance lower than 5%.

Conclusion: E. coli is the most common organism causing UTIs in infants; however, other bacterial strains are frequently isolated. As a result, antibiotic prophylaxis should be more elastic and adaptable over time in order to guarantee maximum efficacy.

Publication types

  • Review

MeSH terms

  • Amoxicillin / pharmacology
  • Cephalosporins / pharmacology
  • Drug Resistance, Bacterial
  • Enterococcus / isolation & purification
  • Escherichia coli / drug effects
  • Escherichia coli / isolation & purification
  • Europe
  • Humans
  • Infant
  • Kidney / abnormalities
  • Klebsiella / isolation & purification
  • Nitrofurantoin / pharmacology
  • Prospective Studies
  • Proteus / isolation & purification
  • Pseudomonas / isolation & purification
  • Surveys and Questionnaires
  • Trimethoprim / pharmacology
  • Urinary Tract Infections / microbiology*
  • Urine / microbiology

Substances

  • Cephalosporins
  • cephalosporin 112384
  • Amoxicillin
  • Nitrofurantoin
  • Trimethoprim