Development of antibiotics resistance in children using prophylactic antibiotics for recurrent urinary tract i̇nfections. A retrospective cohort analysis

ABSTRACT Karagöz K. Development of Antibiotics Resistance in Children Using Prophylactic Antibiotics for Recurrent Urinary Tract İnfections. A Retrospective Cohort Analysis, Bulent Ecevit University School of Medicine, Children's Health and Diseases, Master Thesis: Zonguldak, 2014. Objective: Urinary tract infection is the most common infectious diseases in childhood after upper respiratory tract infections. With early detection and treatment, the development of complications such as renal damage, proteinuria, hypertension, decreased glomerular filtration and chronic renal failure are prevented. Prophylaxis is used for prevention of recurrent urinary tract infection in patients with high risk. However, long-term prophylactic use of antibiotics is thought to be associated with the development of resistance. In our study, we aimed to investigate the effect of prophylactic use of antibiotics for recurrent urinary tract infections on the development of resistance in childhood. Material and Methods: A total of 150 patients aged 0-16 were included in this study, who admitted to Bülent Ecevit University School of Medicine, Child Health and Diseases Department between January 1, 2008 - August 1, 2012, 100 of these not receiving prophylaxis and 50 of these receiving prophylaxis with a diagnosis of urinary tract infection. Results of laboratory tests and radiological imaging of the patients were evaluated retrospectively. Results: 65 of the patients (43.3%) were males and 85 of the patients (56.7%) were girls. The group receiving prophylaxis was consisted of 22 (44%) males and 28 (56%) girls, the group not receiving prophylaxis was consisted of 43 (43%) men and 57 (57%) girls. The average age of the cases was 47.3 ± 47.0 months in the group receiving prophylaxis and the average age of the cases was 40.4 ± 42.7 months in the group not receiving prophylaxis. In both groups, no statistically significant difference was detected in terms of age and gender. Male urinary tract infections in the first year of life was higher in children than later years and females (P = 0.007). Presence of leukocytes in the urine biochemical analysis was found to be sensitive for reproduction of Escherichia coli in that culture. In our patients, the most frequently used prophylactic antibiotic was trimethoprim-sulfamethoxazole (62%). In both groups, Escherichia coli took the first place with an isolation rate of 64% and was follewed by Klebsiella pneumoniae, Proteus mirabilis, Klebsiella oxytoca, Enterobacter auerogenes, Pseudomonas spp, Morganella morgani, Serratia marcescens in order of frequency. Escherichia coli was the most frequently isolated microorganism in boys and girls. But, Escherichia coli was isolated significantly higher in girls than boys (p = 0.005). When compared in both groups, the use of prophylactic antibiotics did not increase antibiotic resistances in later culture reproductions (p < 0.05). In patients, the highest resistance was against to ampicillin (71.9%) and it was followed by piperacillin, cephalothin, trimethoprim- sulfamethoxazole, cefuroxime, amoxicillin / klavunik acid, ceftriaxone in order of frequency. In both groups, isolated Pseudomonas spp. in all urine cultures was sensitive to aztreonam, meropenem, ceftazidime and colistin. Also, in cases that Escherichia coli isolated in urine cultures and taken prophylaxis, more resistance against amoxicillin/klavunik acid, ceftriaxone and piperacillin were observed than the other groups. Conclusion: In our study, it was observed that the use of prophylactic antibiotics did not cause an increase in resistance development. But we alsofound an increase in the development of resistances to antibiotics in urinary tract infections. For these reasons, we suggest periodical studies inevery regions for specific resistances and make empiric antibiotic choices for treatments in the lights of these studies. Key words: Urinary tract infection, Prophylaxis, Antibiotic resistance