Urinary tract infection (UTI) is a common bacterial infection in infants and children. Trimethoprim is usually the first-line antibiotic used in this setting, especially for the treatment of coliform/Escherichia coli UTI. Regular use of antibiotics is a platform for the emergence of resistant strains. Recent guidelines published by the National Institute for Health and Clinical Excellence (NICE) in the UK advises laboratories to monitor resistance patterns to urinary pathogens and use antibiotics with a low resistance pattern. The aim of our project was to evaluate the resistance pattern to commonly used antibiotics in children with culture-proved UTI.
We retrospectively analysed all cases with confirmed UTI from 2002 to 2006. Cases were identified by the clinical coding system and data were obtained from the Hospital Information Support System. Microbiology results were analysed to evaluate the sensitivities to trimethoprim, cefalexin, nitrofurantoin and augmentin. 413 cases were identified; 90% (371/413) grew E coli as a single organism. An increasing resistance to trimethoprim and nitrofurantoin was observed among these patients over a period of 5 years (table).
These comprehensive data on children with UTI in a district general hospital suggest an increasing resistance pattern to first-line antibiotics. Large-scale prospective studies are urgently required to investigate this matter further. If consistent results are found, cefalexin should be considered as a suitable alternative first-line oral antibiotic to treat UTI in children.