Prophylactic antibiotics overused for UTIs
Of the children diagnosed with a first UTI, 83 (13.6%) developed a recurrent UTI, defined as a second positive urine culture two or more weeks after therapy for the first UTI. Fully 61% of these recurrent UTIs were caused by a pathogen with antimicrobial resistance—mostly (78%) Escherichia coli.
Several factors were associated with an increased risk for recurrent UTI. They included white race and being between the ages of 3 and 5, both of which doubled the risk. Having grade 4 or grade 5 vesicoureteral reflux increased the risk more than four times. In addition, the risk for antimicrobial resistance among children with recurrent UTI was increased more than sevenfold.
The authors note that race may also play a role in risk of recurrent UTIs and resistant infections. “Nonwhites had a decreased risk of recurrent UTI, yet an increased risk of resistant infections,” they write. “All nine recurrent UTIs in nonwhites exposed to prophylactic antimicrobials were caused by a resistant organism” (JAMA. 2007; 298:179-186).