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Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates

Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates
Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates
Background: Antibiotic treatment recommendations based on susceptibility data from routinely submitted urine samples may be biased because of variation in sampling, laboratory procedures and inclusion of repeat samples, leading to uncertainty about empirical treatment.

Objective: To describe and compare susceptibilities of Escherichia coli cultured from routinely submitted samples, with E. coli causing urinary tract infection (UTI) from a cohort of systematically sampled, acutely unwell children.

Methods: Susceptibilities of 1458 E. coli isolates submitted during the course of routine primary care for children <5 years (routine care samples), compared to susceptibilities of 79 E. coli isolates causing UTI from 5107 children <5 years presenting to primary care with an acute illness [systematic sampling: the Diagnosis of Urinary Tract infection in Young children (DUTY) cohort].

Results: The percentage of E. coli sensitive to antibiotics cultured from routinely submitted samples were as follows: amoxicillin 45.1% (95% confidence interval: 42.5–47.7%); co-amoxiclav using the lower systemic break point (BP) 86.6% (84.7–88.3%); cephalexin 95.1% (93.9–96.1%); trimethoprim 74.0% (71.7–76.2%) and nitrofurantoin 98.2% (97.4–98.8%). The percentage of E. coli sensitive to antibiotics cultured from systematically sampled DUTY urines considered to be positive for UTI were as follows: amoxicillin 50.6% (39.8–61.4%); co-amoxiclav using the systemic BP 83.5% (73.9–90.1%); co-amoxiclav using the urinary BP 94.9% (87.7–98.4%); cephalexin 98.7% (93.2–99.8%); trimethoprim 70.9% (60.1–80.0%); nitrofurantoin 100% (95.3–100.0%) and ciprofloxacin 96.2% (89.4–98.7%).

Conclusion: Escherichia coli susceptibilities from routine and systematically obtained samples were similar. Most UTIs in preschool children remain susceptible to nitrofurantoin, co-amoxiclav and cephalexin.
0263-2136
127-132
Butler, Christopher C.
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O'Brien, Kathryn
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Wootton, Mandy
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Pickles, Timothy
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Hood, Karenza
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Howe, Robin
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Waldron, Cherry-Ann
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Thomas-Jones, Emma
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Dudley, Jan
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Van Der Voort, Judith
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Rumsby, Kate
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Little, Paul
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Downing, Harriet
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Harman, Kim
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Hay, Alastair D.
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Butler, Christopher C.
2782a915-eb8d-48bb-ae70-118114697f57
O'Brien, Kathryn
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Wootton, Mandy
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Pickles, Timothy
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Hood, Karenza
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Howe, Robin
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Waldron, Cherry-Ann
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Thomas-Jones, Emma
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Dudley, Jan
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Van Der Voort, Judith
d35b2ed1-6e26-4d2e-aa21-62cc637e78e6
Rumsby, Kate
2002ee8a-32ac-4119-869d-ed35164c3b51
Little, Paul
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Downing, Harriet
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Harman, Kim
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Hay, Alastair D.
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Butler, Christopher C., O'Brien, Kathryn, Wootton, Mandy, Pickles, Timothy, Hood, Karenza, Howe, Robin, Waldron, Cherry-Ann, Thomas-Jones, Emma, Dudley, Jan, Van Der Voort, Judith, Rumsby, Kate, Little, Paul, Downing, Harriet, Harman, Kim and Hay, Alastair D. (2016) Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates. Family Practice, 33 (2), 127-132. (doi:10.1093/fampra/cmv104). (PMID:26984993)

Record type: Article

Abstract

Background: Antibiotic treatment recommendations based on susceptibility data from routinely submitted urine samples may be biased because of variation in sampling, laboratory procedures and inclusion of repeat samples, leading to uncertainty about empirical treatment.

Objective: To describe and compare susceptibilities of Escherichia coli cultured from routinely submitted samples, with E. coli causing urinary tract infection (UTI) from a cohort of systematically sampled, acutely unwell children.

Methods: Susceptibilities of 1458 E. coli isolates submitted during the course of routine primary care for children <5 years (routine care samples), compared to susceptibilities of 79 E. coli isolates causing UTI from 5107 children <5 years presenting to primary care with an acute illness [systematic sampling: the Diagnosis of Urinary Tract infection in Young children (DUTY) cohort].

Results: The percentage of E. coli sensitive to antibiotics cultured from routinely submitted samples were as follows: amoxicillin 45.1% (95% confidence interval: 42.5–47.7%); co-amoxiclav using the lower systemic break point (BP) 86.6% (84.7–88.3%); cephalexin 95.1% (93.9–96.1%); trimethoprim 74.0% (71.7–76.2%) and nitrofurantoin 98.2% (97.4–98.8%). The percentage of E. coli sensitive to antibiotics cultured from systematically sampled DUTY urines considered to be positive for UTI were as follows: amoxicillin 50.6% (39.8–61.4%); co-amoxiclav using the systemic BP 83.5% (73.9–90.1%); co-amoxiclav using the urinary BP 94.9% (87.7–98.4%); cephalexin 98.7% (93.2–99.8%); trimethoprim 70.9% (60.1–80.0%); nitrofurantoin 100% (95.3–100.0%) and ciprofloxacin 96.2% (89.4–98.7%).

Conclusion: Escherichia coli susceptibilities from routine and systematically obtained samples were similar. Most UTIs in preschool children remain susceptible to nitrofurantoin, co-amoxiclav and cephalexin.

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Accepted/In Press date: 18 December 2015
e-pub ahead of print date: 16 March 2016
Published date: April 2016
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 390642
URI: https://eprints.soton.ac.uk/id/eprint/390642
ISSN: 0263-2136
PURE UUID: 3f58fb3c-0715-4062-b27f-d221d1ce90b3
ORCID for Kate Rumsby: ORCID iD orcid.org/0000-0002-8573-3718
ORCID for Kim Harman: ORCID iD orcid.org/0000-0002-5173-7753

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Date deposited: 07 Apr 2016 08:03
Last modified: 01 Oct 2019 05:38

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