Perfil de resistencia a los antimicrobianos en agentes causantes de infección del tracto urinario en niños chilenos: programa de vigilancia PRONARES / Antimicrobial susceptibility of agents causing urinary tract infections in chilean children: PRONARES surveillance program

RESUMO

Background: PRONARES (Programa Nacional de Vigilancia de Resistencia) is a national surveillance program for antimicrobial susceptibility, focused in different syndromes and among these, urinary tract infections. The work is done in a laboratory net that uses common protocols and whose data are centrally analyzed using the WHONET program. Aim: To analyze the pattern of antimicrobial susceptibility of agents causing urinary infections in children in the period 1997-1999. Material and methods: In the study period, 5,525 strains were analyzed. Of these, 2,307 came from pediatric patients (1,495 hospitalized and 803 ambulatory). Results: The most common causative agent was E. coli in 74,2 percent of cases, followed by Klebsiella spp in 8,2 percent and other agents in a lower frequency. Of E. coli strains, 74 percent were resistant to ampicillin, 52 percent to clotrimoxazole and 30 percent to first generation cephalosporins. These strains were sensitive to second and third generation cephalosporins, aminoglycosides, ciprofloxacin and nitrofurantoin. Strains from nosocomial or community infections had similar antimicrobial susceptibility. Klebsiella spp had a high rate of antimicrobial resistance (over 40 percent), that was even higher among nosocomial strains. It was 90 percent susceptible to ciprofloxacin and 100 percent to imipenem. All centers from which strains came had a similar pattern of susceptibility, with the exception of a pediatric center that had significantly higher resistance levels. Conclusions: The current therapeutic recommendations for urinary tract infections in children caused by E coli, are still pertinent, but the use of first generation cephalosporins must be cautious. The treatment of Klebsiella spp requires an individual antibiogram