PDF(Pubmed)
Abstract：
Urinary tract infections (UTIs) in childhood are common and are associated with considerable acute morbidity and long-term complications. The need for updated data to optimize empiric antibiotic therapy is crucial. We aimed to investigate the pathogens causing pediatric community acquired UTIs, their correlation with demographic characteristics, and trends in their antimicrobial resistance. This nationwide cross-sectional study included all 53,203 children (<18 years) diagnosed with UTI in community outpatient clinics in the following selected years: 2007, 2011, 2015, 2019 and 2021. Escherichia coli (E. coli) (82.1%) was the most common uropathogen, followed by Enterobacter, Klebsiella, Proteus, Pseudomonas, and Enterococcus species. The bacterial distribution displayed statistically significant (p < 0.0001) gender- and sector-specific patterns with a higher relative prevalence of non-E. coli UTI in Jewish and males. The rate of extended-spectrum beta-lactamase-positive E. coli increased substantially and significantly (p < 0.001) from only 6.1% in 2007 to 25.4% in 2021. Most non-E. coli uropathogens exhibited resistance to commonly used empiric antibiotics for UTIs in children. These findings are significant in guiding optimal empiric antibiotic treatment for pediatric community acquired UTIs. The resistance of uropathogens to antimicrobials is region- and time-dependent. Therefore, the periodic and local assessment of antibiotic resistance trends is essential to update guidelines and provide the most appropriate antibacterial therapy for children with UTIs.
摘要：
儿童尿路感染（UTI）很常见，并伴有相当大的急性发病率和长期并发症。需要更新的数据来优化经验性抗生素治疗是至关重要的。我们旨在调查引起儿科社区获得性UTI的病原体，它们与人口统计学特征的相关性，以及抗菌素耐药性的趋势。这项全国性的横断面研究包括以下选定年份在社区门诊诊断为UTI的所有53,203名儿童（<18岁）：2007年，2011年，2015年，2019年和2021年。大肠杆菌(E.大肠杆菌)(82.1%)是最常见的尿路病原体，其次是肠杆菌,克雷伯菌属,Proteus,假单胞菌,和肠球菌。细菌分布显示出统计学上显着（p<0.0001）的性别和部门特异性模式，非E的相对患病率更高。犹太人和男性的大肠杆菌UTI。超广谱β-内酰胺酶阳性大肠杆菌的比率从2007年的6.1%显著增加到2021年的25.4%(p<0.001)。大多数非E。大肠埃希菌对儿童尿路感染的常用经验性抗生素表现出耐药性。这些发现对于指导儿科社区获得性UTI的最佳经验性抗生素治疗具有重要意义。尿路病原体对抗菌药物的耐药性是区域和时间依赖性的。因此,定期和局部评估抗生素耐药性趋势对于更新指南和为患有UTI的儿童提供最合适的抗菌治疗至关重要.
