Korean J Urol.  2009 Dec;50(12):1219-1224.

Risk Factors for Ciprofloxacin-Resistant Escherichia coli Strains in Pediatric Patients with Acute Urinary Tract Infection

• Hong JH
• Yu J
• Lee G

Abstract

PURPOSE
Previous exposure to fluoroquinolone is an important risk factor for acquiring resistant strains of microorganisms. However, the mechanisms of fluoroquinolone resistance in Escherichia coli from pediatric patients with urinary tract infection (UTI) are not well defined because fluoroquinolone prescription for children is not permitted around the world. We investigated the risk factors for ciprofloxacin-resistant E. coli isolates from the urine of pediatric patients with UTI.
MATERIALS AND METHODS
Data from 72 patients who showed > or =10(5) E. coli colony-forming units in urine culture were retrospectively collected from a university hospital between June 2006 and June 2009. The minimum inhibitory concentration of ciprofloxacin resistance was determined by the agar dilution method on Mueller-Hinton agar.
RESULTS
The rates of E. coli resistance to ciprofloxacin, cefazolin, ampicillin, co-trimoxazole, and fosfomycin were 8.3%, 20.8%, 77.7%, 25%, and 0%, respectively. Differences in sex, age intervals, and previous antimicrobial use in recent years were significantly associated with ciprofloxacin resistance, whereas admission level, the presence of fever, and the type of UTI were not. In addition, female gender, previous antimicrobial use, and older age significantly increased the risk for ciprofloxacin resistance in a univariate analysis. Only co-trimoxazole resistance was positively associated with ciprofloxacin resistance, whereas resistance to other antimicrobials was not.
CONCLUSIONS
Even though the incidence was not high, ciprofloxacin resistance was found in E. coli from pediatric UTIs. Because the characteristics of ciprofloxacin resistance in pediatric patients are not well defined, further study of the mechanism of acquiring ciprofloxacin resistance in children is needed.

Keyword

Ciprofloxacin; Urinary tract infections; Pediatrics; Escherichia coli

MeSH Terms

Agar
Ampicillin
Cefazolin
Child
Ciprofloxacin
Escherichia
Escherichia coli
Female
Fever
Fosfomycin
Humans
Incidence
Microbial Sensitivity Tests
Pediatrics
Prescriptions
Retrospective Studies
Risk Factors
Stem Cells
Trimethoprim, Sulfamethoxazole Drug Combination
Urinary Tract
Urinary Tract Infections
Agar
Ampicillin
Cefazolin
Ciprofloxacin
Fosfomycin

Reference

1. Park J, Min K, Kang D. The efficacy and safety of a once-daily extended-release ciprofloxacin tablet for the empirical treatment of symptomatic uncomplicated cystitis in Korean women. Korean J Urol. 2007. 48:35–39.

2. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis. 1999. 29:745–758.

3. Cockerill FR, Edson RS. Trimethoprim-sulfamethoxazole. Mayo Clin Proc. 1991. 66:1260–1269.

4. Song HJ, Kim SJ. A study of antimicrobial sensitivity to the causative organism of urinary tract infection. Korean J Urol. 2005. 46:68–73.

5. Kim ME, Ha US, Cho YH. Prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in female outpatients in South Korea: a multicentre study in 2006. Int J Antimicrob Agents. 2008. 31:Suppl 1. S15–S18.

6. Pallecchi L, Bartoloni A, Paradisi F, Rossolini GM. Antibiotic resistance in the absence of antimicrobial use: mechanisms and implications. Expert Rev Anti Infect Ther. 2008. 6:725–732.

7. Davidson RJ, Davis I, Willey BM, Rizg K, Bolotin S, Porter V, et al. Antimalarial therapy selection for quinolone resistance among Escherichia coli in the absence of quinolone exposure, in tropical South America. PLoS One. 2008. 3:e2727.

8. Wang A, Yang Y, Lu Q, Wang Y, Chen Y, Deng L, et al. Presence of qnr gene in Escherichia coli and Klebsiella pneumoniae resistant to ciprofloxacin isolated from pediatric patients in China. BMC Infect Dis. 2008. 8:68.

9. Koh JI, Kim JM, Shin HB, Kim ME. Antibiotic resistance patterns of Escherichia coli in pediatric urinary tract infections for 8 years from 2001 to 2008. Korean J UTII. 2009. 14:47–55.

10. Chang IH, Bang SH, Choi NY, Park SY, Han JH, Ahn SH. Trends in the emergence of ciprofloxacin-resistant Escherichia coli and the relationship with underlying diseases in patients with urinary tract infection. Korean J Urol. 2008. 49:66–71.

11. Lee SJ, Cho YH, Kim BW, Lee JG, Jung SI, Lee SD, et al. A multicenter study of antimicrobial susceptibility of uropathogens causing acute uncomplicated cystitis in woman. Korean J Urol. 2003. 44:697–701.

12. Schaeffer AJ, Schaeffer EM. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Infections of the urinary tract. Campbell-Walsh urology. 2007. 9th ed. Philadelphia: Saunders;223–303.

13. Porter RD. Streips UN, Yasbin RE, editors. Conjugation. Modern microbial genetics. 2002. 2nd ed. New York: Wiley-Liss Inc;463–506.

14. Perry AC, Prpa B, Rouse MS, Piper KE, Hanssen AD, Steckelberg JM, et al. Levofloxacin and trovafloxacin inhibition of experimental fracture-healing. Clin Orthop Relat Res. 2003. 414:95–100.

15. Gobernado M, Valdés L, Alós JI, Garcia-Rey C, Dal-Ré R, García-de-Lomas J. Quinolone resistance in female outpatient urinary tract isolates of Escherichia coli: age-related differences. Rev Esp Quimioter. 2007. 20:206–210.

16. Lin CY, Huang SH, Chen TC, Lu PL, Lin WR, Chen YH. Risk factors of ciprofloxacin resistance in urinary Escherichia coli isolates. J Microbiol Immunol Infect. 2008. 41:325–331.

17. Morgan-Linnell SK, Becnel Boyd L, Steffen D, Zechiedrich L. Mechanisms accounting for fluoroquinolone resistance in Escherichia coli clinical isolates. Antimicrob Agents Chemother. 2009. 53:235–241.