First UTI episode in infants less than 1 year of age: Clinic
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A retrospective study was done of all the infants less than 1 year hospitalized with their first UTI and followed during their first year of life.

191 infants were enrolled. 69 patients were less than 2 months and 32 developed R-UTI during the follow-up. The five most common uropathogens were Escherichia coli, Klebsiella spp, Enterococcus spp, Proteus mirabilis and Staphylococcus aureus.

High resistance rates were recorded for ampicillin, amoxicillin/clavulanic acid, TMP/SMX, cefuroxime, ceftriaxone, piperacillin/tazobactam and gentamicin among. E. coli and Klebsiella spp. were the most frequent R-UTI pathogens. 25 R-UTIs were caused by recurrent uropathogens representing new infections. Antibiotic resistance rates at recurrence were similar to those at initial UTI, except for a significant increase in E. coli and Klebsiella spp. resistance to piperacillin/tazobactam.

As a result, the protocol for initial empiric treatment of infants with suspicion of UTI was modified by changing gentamicin to amikacin in the treatment of infants less than 2 months of life and amikacin monotherapy (intravenous or intramuscular) was introduced as first-line therapy for infants greater than 2 months of life.

Source: https://www.pediatr-neonatol.com/article/S1875-9572(20)30108-X/fulltext?rss=yes
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