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Multidrug-resistant organisms in urinary tract infections in children

  • Michelle Mahony
  • Brendan McMullan
  • Jeremy Brown
  • Sean E KennedyEmail author
Review

Abstract

The global spread of multidrug-resistant organisms has led to an increase in urinary tract infections (UTIs) in children that are difficult to treat. This review explores the current literature regarding multidrug-resistant UTIs in childhood and proposes an approach to management. Multidrug-resistant organisms include a wide range of potential urinary tract pathogens and, while most literature on drug resistance in UTIs during childhood has focused on extended-spectrum beta-lactamase producing organisms, in this review, we have included a discussion of multidrug resistance including and beyond beta-lactamase production. We provide definitions for multidrug-resistant organisms in line with current consensus guidelines and summarise clinically relevant mechanisms of resistance. Additionally, in this review, we outline the global epidemiology of multidrug-resistant UTIs in children, summarising published prevalence rates, which range from 5 to 90% in different settings. Finally, we also critically review the evidence on risk factors for colonisation and infection of the urinary tract with multidrug-resistant organisms, including prior antibiotic use, hospitalisation and underlying urological malformations. We also highlight multidrug-resistant UTI occurring in children without any identifiable risk factors, reflecting an increasing prevalence of colonisation with these organisms in the general community. Taken as a whole, this emphasises a need for careful and evidence-based use of antibiotics when treating UTIs in children and, to aide clinicians, we have outlined here potential management strategies for when infection with a multidrug-resistant organism is suspected or confirmed.

Keywords

Urinary tract infection Children Multidrug resistance Extended-spectrum beta-lactamases 

Notes

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Copyright information

© IPNA 2019

Authors and Affiliations

  1. 1.School of Women’s & Children’s Health, UNSW MedicineUniversity of New South WalesSydneyAustralia
  2. 2.Department of Immunology and Infectious DiseasesSydney Children’s HospitalRandwickAustralia
  3. 3.National Centre for Infections in Cancer, Peter MacCallum Cancer CentreMelbourneAustralia
  4. 4.Department of Infectious DiseasesBlacktown HospitalSydneyAustralia
  5. 5.Department of Infectious DiseasesNepean HospitalSydneyAustralia
  6. 6.Department of NephrologySydney Children’s HospitalRandwickAustralia

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