MULTIDRUG RESISTANT MANAGEMENT OF URINARY TRACT INFECTIONS IN PEDIATRICS

Introduction: urinary tract infection (UTI) is a common clinical problem in pediatric hospitals that represents one of the most common diseases in childhood; diagnosis is based on urine culture, being the Escherichia coli the main isolated pathogen. Conventionally, the management decision is based on four factors: the bacteria and their sensitivity, localization of infection, clinical status and age of the patient, however, this treatment should begin long before knowing the germ and its susceptibility profile. The increasing incidence of gram-negative pathogens resistant to common antimicrobial drugs have led serious difficulties with regard to their treatment, leaving aside the use of classical antibiotics or first line, suspecting multiresistance. Objective: to make a systematic review in order to identify concepts related to the mechanism of resistance in various gram-negative germs, species of multi resistant germs and treatments for multiresistant UTI. Material and methods: the review was conducted on the basis MEDLINE (1990 to May 2015), CLINICAL KEYS (2001 to March 2015), PUBMED (no deadline) data and reference lists of articles. The bibliographic search showed 43 possible research papers, of which 20 were taken into account to develop this review. Results: carbapenems such as imipenem, meropenem and ertapenem become the first line treatment of infections due to bacteria producing beta-lactamases of extended spectrum (ESBL). However, it has been seen that quinolones and aminoglycosides can show comparable results. Unfortunately, the resistance of these groups is higher. Conclusion: as time goes by, gram-negative bacteria have developed new and more efficient ways of resistance, therefore the emergence of new forms of UTI are more resistant to conventional therapy. That is the reason why the treatment should be individualized according to the local epidemiology of each population. Rev.cienc.biomed. 2015;6(2):340-347 KEYWORDS Urinary Tract Infections; Pediatrics; Gram-Negative rods; Drug resistance; Multiple, Bacterial; Bacteria beta-Lactamases