Three-Year Trend in <i>Escherichia coli</i> Antimicrobial Resistance among Children's Urine Cultures in an Italian Metropolitan Area

• Main Authors: Luca Pierantoni (Author), Laura Andreozzi (Author), Simone Ambretti (Author), Arianna Dondi (Author), Carlotta Biagi (Author), Francesco Baccelli (Author), Marcello Lanari (Author)
• Format: Book
• Published: MDPI AG, 2021-07-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.3390/children8070597; 2227-9067
• Keywords: bacterial infections; urinary tract infections; <i>Escherichia coli</i>; antimicrobial resistance; children; amoxicillin clavulanate; Pediatrics; RJ1-570
• Source: Children, Vol 8, Iss 7, p 597 (2021)

Urinary tract infections (UTIs) are among the most common bacterial infections in children, and <i>Escherichia coli</i> is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of <i>E. coli</i> isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of <i>E. coli</i>-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (<i>p</i> < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (<i>p</i> = 0.007). The prevalence of multidrug-resistant <i>E. coli</i> rose from 3.9% to 9.2% (<i>p</i> = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant <i>E. coli</i> among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.