Pathogenic bacteria distribution and antimicrobial resistance in children aged 0 to 14 years with urinary tract infections in a single center in Shanghai / 中华传染病杂志

ABSTRACT

Objective:To investigate the distribution and antimicrobial resistance patterns of common pathogens in children with urinary tract infections in a single center in Shanghai, and to provide basis for the selection of empirical antibiotics in the clinical practice.Methods:The clinical data, urine culture and drug sensitivity tests results of children with urinary tract infections between 0 to 14 years admitted to the Children′s Hospital of Fudan University from January 2016 to December 2019 were retrospectively analyzed. According to the time of onset and the complicated factors, the patients were divided into different groups. The distributions and antimicrobial resistance patterns of common pathogens were compared among the groups. The chi-square test was used for statistical analysis.Results:Among the 1 832 children, 1 042 cases had positive urine culture, with the culture positive rate of 56.9%. The top five pathogens detected were Escherichia coli (375 strains, 36.0%), Enterococcus faecium (164 strains, 15.7%), Klebsiella pneumoniae (133 strains, 12.8%), Enterococcus faecalis (95 strains, 9.1%) and Pseudomonas aeruginosa (44 strains, 4.2%). The annual detection rates of gram-negative bacteria (65.3% to 72.9%) were always higher than those of gram-positive bacteria (22.6% to 30.1%). The distributions of pathogens among the years were not significantly different ( χ2 =27.79, P=0.146). In patients with complicated urinary tract infections, the detection rates of Pseudomonas aeruginosa (5.8%(40/688) vs 1.1%(4/354)) and fungi (6.5%(45/688) vs 1.7%(6/354)) were significantly higher than those in patients with simple urinary tract infections ( χ2=12.68 and 11.79, respectively, both P<0.050). Both of Escherichia coli and Klebsiella pneumoniae had the highest resistance rates to ampicillin, which were 87.2%(301/345) and 87.1%(115/132), respectively. The resistance rates of Escherichia coli to amikacin, nitrofurantoin, fosfomycin, cefmetazole, piperacillin/tazobactam, ertapenem, imipenem and meropenem were 1.4%(5/345), 6.1%(21/345), 6.1%(21/345), 8.3%(11/132), 11.6%(40/345), 6.4%(22/345), 4.6%(16/345) and 4.6%(16/345), respectively. The resistance rates of Klebsiella pneumoniae to these drugs were 6.1%(8/132), 37.9%(50/132), 15.2%(20/132), 23.2%(13/56), 26.5%(35/132), 23.5%(31/132), 17.4%(23/132) and 16.7%(22/132), respectively, which were all higher than those of Escherichia coli, and the differences were all statistically significant ( χ2=6.02, 76.17, 9.99, 7.94, 16.04, 28.29, 20.79 and 18.84, respectively, all P<0.050). The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam, piperacillin/tazobactam and ceftazidime were 6.8%(3/44), 4.5%(2/44) and 2.3%(1/44), respectively, while those to carbapenems, amikacin and ciprofloxacin were all 0(0/44). The resistance rate of Enterococcus faecium to ampicillin was 96.8%(153/158), while that of Enterococcus faecalis was 9.1%(8/88). There was no Enterococcus strain resistant to vancomycin, teicoplanin or linezolid. When dynamically comparing the trends of the antimicrobial resistance from 2016 to 2019, the resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams (including carbapenems) antimicrobial agents had shown a downward trend. Conclusions:Gram-negative bacteria are still the main pathogens of urinary tract infections in children, with a downward trend of drug resistance rates to β-lactams (including carbapenems) antimicrobial agents.