Antibiotic resistance patterns of urinary tract pathogens in Turkish children

Background:Knowledge of local antimicrobial resistance patterns is essential for evidence-based empirical antibiotic prescribing.We aimed to investigate the distribution and changes in causative agents of urinary tract infections in children and the resistance rates,and to recommend the most appropriate antibiotics.Methods:In this retrospective study,we evaluated causative agents and antimicrobial resistance in urine isolates from the positive community from September 2014 to April 2016 in a single hospital in Ankara,Turkey.Results:A total of 850 positive urine cultures were identified,of which 588(69.2%)were from girls and 262(30.8%)were from boys.Their mean age was 36.5±45.0 months.The most common causative agent was Escherichia coli(64.2%of cases)followed by Klebsiella pneumoniae(14.9%).The overall resistance to ampicillin(62.6%),cephalothin(44.2%),co-trimoxazole(29.8%)and cefuroxime(28.7%)was significant.No resistance to imipenem was detected in the isolates.The least resistance was for amikacin,ceftriaxone,ciprofloxacin and cefepime(0.1,2.4,7.5 and 8.3%,respectively).Imipenem was the most active agent against E.coli followed by amikacin(0.2%),ceftriaxone(2.7%)and nitrofurantoin(5.1%).High resistance rates to nitrofurantoin were detected in K.pneumoniae,Proteus and Enterobacteriae.Conclusions:E.coli was the most common causative agent of urinary tract infection in children.Ampicillin,trimethoprim-sulfometaxazole,cephalothin and cefuroxim had the highest resistance rates against urinary tract pathogens in our center.For oral empirical antibiotherapy,cefixime is the most appropriate choice so as to include Klebsiella strains.