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Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group


Knowledge of the distribution spectrum of causative organisms and their resistance patterns has become a core requirement for the rational and effective management of urinary tract infections. In the context of a prospective trial on the use of antibiotic prophylaxis in infants with underling kidney malformations, we conducted an online survey among paediatric nephrologists on positive urine cultures (July 2010–June 2012) from both hospitalized and non-hospitalized infants under 24 months of age. We collected 4745 urine cultures (UCs) at 18 units in 10 European countries. Escherichia coli was the most frequent bacterium isolated from UCs; however, in 10/16 hospitals and in 6/15 community settings, E. coli was isolated in less than 50 % of the total positive UCs. Other bacterial strains were Klebsiella, Enterococcus, Proteus and Pseudomonas not only from hospital settings. E. coli showed a high resistance to amoxicillin and trimethoprim and variable to cephalosporin. Nitrofurantoin had a good rate of efficacy, with 11/16 hospitals and 11/14 community settings reporting a resistance lower than 5 %.

Conclusion: E. coli is the most common organism causing UTIs in infants; however, other bacterial strains are frequently isolated. As a result, antibiotic prophylaxis should be more elastic and adaptable over time in order to guarantee maximum efficacy.

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Clinical and Laboratory Standards Institute


European Committee for Antimicrobial Susceptibility Testing


Urine cultures


Urinary tract infection


Vesico-ureteral reflux


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Thanks to all the microbiology departments for the support given to the authors in the selection of the data: Simone Ambretti (Bologna), Akgun Yaman (Adana), Joanna Klepacka (Krakow), Derya Aydin (Istanbul), Jaulhac Benoit (Strasbourg), Emilie Bessede (Bordeaux), Genovaite Bernatoniene (Vilnius), Suzana Laban-Nestorović (Belgrade), Eva Kenesei (Budapest), Nigar Çelik Özer (Istanbul), SC Droz (Bern), Anna Komarnicka (Gdansk), Lucia Rossi (Padova), Irene Burckhardt (Heidelberg) and Johannes Huebner (Munich).

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Correspondence to Giovanni Montini.

Additional information

Communicated by Jaan Toelen

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Alberici, I., Bayazit, A.K., Drozdz, D. et al. Pathogens causing urinary tract infections in infants: a European overview by the ESCAPE study group. Eur J Pediatr 174, 783–790 (2015). https://doi.org/10.1007/s00431-014-2459-3

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  • Urinary tract infection
  • Antibiotic resistance
  • Infants
  • Escherichia coli
  • Urine culture