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Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i939 (Published 15 March 2016) Cite this as: BMJ 2016;352:i939

Re: Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

The article by Bryce et al. addresses the important growing concern that is antibiotic resistance. The researchers chose to conduct a systematic review and meta-analysis of this issue amongst the pediatric population with community acquired urinary tract infections caused by E. Coli. The data gathered by this team is impressive; it covered a wide range of countries and provided important statistics in terms of the different antibiotics used to treat urinary tract infections. In Canada, the recommended guidelines for treatment of urinary tract infections include the use of trimethoprim and nitrofurantoin, however it seems that ciprofloxacin is used more often (Public Health Agency of Canada, 2016). Interestingly enough, in the results found by Bryce et al., ciprofloxacin is shown to cause more resistance in children than nitrofurantoin did. This of importance for implication to practice in Canada; the recommendations and guidelines should be reinforced within our health care settings.

The eligibility criteria for this study was very well defined; it clearly stated that it only included children who had provided a urine sample. However, a recent study attributed the increase in antibiotic resistance in pediatric urinary tract infections to the lack of urine specimen collection for analysis and culture prior to treatment (Edlin & Copp, 2014); including this population in the study would have given a more in-depth investigation into the growing resistance. Further research on this topic should include inpatient data because there is a higher antibiotic resistance for urinary tract infections seen in this population than in the outpatient or community population (Edlin & Copp, 2014).

Being the first article “to explore and report global evidence regarding the prevalence of bacterial resistance in children’s urinary tract infections” (Bryce et al., 2016), this review is of great importance in nursing practice as is reminds us of the important concepts of disease prevention and health promotion (WHO, 2016). These notions aim to avoid disease manifestation and to empower the population to gain control over their own health (WHO, 2016). Nurses in primary care settings can direct parents to resources to increase their knowledge on different pediatric health issues and illness prevention. For example, the Canadian website Caring for Kids (www.caringforkids.cps.ca) provides parents with information on various childhood illnesses and gives parents guidelines for their prevention, including methods the prevent urinary tract infections.

References

Edlin, R. S., & Copp, H. L. (2014). Antibiotic resistance in pediatric urology. Therapeutic Advances in Urology, 6(2), 54–61. http://doi.org/10.1177/1756287213511508

Public Health Agency of Canada (2016). Canadian Antimicrobial Resistance Surveillance System – Report 2016. Retrieved from http://healthycanadians.gc.ca/publications/drugs-products-medicaments-pr...

World Health Organization (2016). Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity. Retrieved from http://www.emro.who.int/about-who/public-health-functions/health-promoti...

Competing interests: No competing interests

23 November 2016
Valerie De Broux
RN, MSc(A) Candidate
Brantford,ON