Urinary tract infections in hospital pediatrics: many previous antibiotherapy and antibiotics resistance, including fluoroquinolones.

OBJECTIVE: We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population. METHODS: We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record. RESULTS: One hundred and ten patients (73 girls), 11 days to 12 years of age, were included in 10 months. Ninety-six percent presented with pyelonephritis, associated to uropathy for 25%. Escherichia coli was predominant (78%), followed by Proteus spp. and Enterococcus spp. The antibiotic resistance rate of E. coli was high and close to that reported for adults with complicated UTIs: amoxicillin 60%, amoxicillin-clavulanate 35%, cefotaxim 5%, trimethoprim-sulfametoxazole 26%, nalidixic acid 9%, ciprofloxacin 7%, gentamycin 1%, nitrofurantoin and fosfomycin 0%. The antibiotic exposure in the previous 12 months involved 62 children (56%) most frequently with ß-lactams (89%) for a respiratory tract infection (56%). A clear relationship between exposure and resistance was observed for amoxicillin (71% vs. 46%), first generation (65% vs. 46%) and third generation (9% vs. 3%) cephalosporins, or trimethoprim-sulfamethoxazole (36% vs. 15%). However, antibiotic exposure could not account alone for the results, as suggested by the 7% of ciprofloxacin resistance, observed without any identified previous treatment. CONCLUSION: Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved (previous antibiotic therapies and fecal-oral or mother-to-child transmission).

[Acute diarrhoea due to Campylobacter jejuni in children (author's transl)]. / Diarrhées aiguës à Campylobacter jejuni chez l'enfant. 3 observations.

A systematic search for Campylobacter jejuni in stool cultures from children with acute diarrhoea showed within two months that the organism was present in 3 out of 17 children. Apart from diarrhoea, the symptoms were different in each case: one child had febrile dysentery, another exhibited symptoms resembling appendicitis and the third one had chronic diarrhoea with denutrition. The condition regressed spontaneously in two cases and after erythromycin treatment in one. Phase-contrast microscope examination of fresh stools may rapidly point to the diagnosis. Routine search for Campylobacter jejuni should yield information on the incidence and epidemiology of these infections in France.