Publicatie

Diagnostic tests and antimicrobial susceptibility of uropathogens in boys and girls with UTI in the Netherlands.

Nys, S., Bartelds, A.I.M., Donker, G., Stobberingh, E.E. Diagnostic tests and antimicrobial susceptibility of uropathogens in boys and girls with UTI in the Netherlands. European Journal of General Practice: 2007, 13(3), p. 185-186. Abstract. EGPRN Meeting in Nijmegen op 11 mei 2007.
Background: in children, urinary tract infections (UTIs) are one of the most common infections encountered by the general practitioner (GP). To minimize renal damage, early diagnosis and adequate empiric antimicrobial therapy are essential. Therefore, this study evaluated the nitrite and leukocyte-esterase (KE) test in childhood UTI, and determined the antibiotic susceptibility of the isolated uropathogens. Research question: Are the diagnostic tests available for the confirmation of a suspected UTI effective in children? What micro-organisms are the most prevalent uropathogens in this population, and what is the susceptibility of the most common antibiotics to treat a UTI? Method: During 2003-2004, GPS from the NIVEL included children (<13 years) presenting with complaints of an acute uncomplicated UTI. The nitrite and/or LE test were performed by the GP, and a dipslide was subsequently sent to the Medical Microbiology Laboratory for identification and antibiotic susceptibility testing of the uropathogens. Results: Forty-two boys and 231 girls participed in the study. The PPV of the nitrite test was 75% and 82 % , repectively , in boys and girls, with an NPV of 78% and 75%. For the LE test, the NPVs were 81% and 82% repectively, for boys and girls. The antimicrobial agents most frequently prescribed in girls were anoxicillin (37%) and co-amoxicav (30%). Escherichia coli was more prevalent in girls (71%) compared to boy (44%; p<0.01). All E. coli were susceptible to nitrofurantoin, and resistance to co-amoxiclav was observed once. The lowest susceptibility percentage was found for amoxicillin (61%). Conclusion: The diagnostic tests available are hulpful for the GP to confirm or rule out infection in paediatric patients. Due to the relatively high prevalence of resistance to amoxicillin, the emiric choice wil now include coamoxiclav and nitrofurantoin.