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An otherwise well, fully immunised 9-year-old boy presented due to systemic malaise with an infected knee laceration 10 days after falling onto concrete in his school playground. On examination his growth parameters were age-appropriate; he was febrile to 39.1℃, with purulent exudate oozing from his knee (figure 1). There was evidence of nodular lymphangitis with lymphocutaneous spread (figure 2). Investigations revealed white cell count of 12.2×109/L with mild neutrophilia (9.37×109/L), C reactive protein of 58 mg/L, and his blood culture was negative. Imaging excluded an underlying bone infection. Figure 1 The …

ObjectiveUrinary tract infections (UTIs) caused by resistant organisms are increasing which poses challenges when selecting empirical antimicrobial therapy. The aim of this study is to determine risk factors for multiresistant Escherichia coli UTIs in children.DesignWe included all reported urinary isolates from a children’s hospital collected between January 2010 and June 2013. Patients who had multiresistant E. coli UTIs were identified and a retrospective review of medical records performed. Patient-specific clinical and demographic factors were compared with age-matched and gender-matched controls with non-multiresistant E. coli UTIs. Univariable and multivariable statistical analysis were performed to determine significant risk factors for multiresistant organism E.coli UTIs.ResultsIn total, there were 2692 positive urine cultures, 1676 (62.3%) from 1169 patients were E. coli. Multiresistant E. coli was isolated from 139 (8.3% of all E. coli) cultures in 99 patients. Thirteen incomplete medical records were excluded, leaving 86 patients, matched with 86 controls. In multivariable regression, the only significant risk factor was antibiotic use in the previous month (adjusted OR 3.0, 95% CI 1.4 to 6.2), but not previous hospital admission (adjusted OR 1.4, 95% CI 0.6 to 2.9), being an inpatient at the time of diagnosis (adjusted OR 2.4, 95% CI 0.8 to 7.4) and previous instrumentation (adjusted OR 1.0, 95% CI 0.4 to 2.4).ConclusionsThis is the first case–control study to examine multiresistant UTI in Australian children. Clinicians should be judicious in the use of antibiotics in treatment and prophylaxis of UTIs. In children presenting with UTI and recent antibiotic exposure, amoxicillin-clavulanic acid appears to be an appropriate empiric antibiotic choice in our population.

Urinary tract infections (UTIs) caused by resistant organisms are increasing which poses challenges when selecting empirical antimicrobial therapy. The aim of this study is to determine risk factors for multiresistantWe included all reported urinary isolates from a children's hospital collected between January 2010 and June 2013. Patients who had multiresistantIn total, there were 2692 positive urine cultures, 1676 (62.3%) from 1169 patients wereThis is the first case-control study to examine multiresistant UTI in Australian children. Clinicians should be judicious in the use of antibiotics in treatment and prophylaxis of UTIs. In children presenting with UTI and recent antibiotic exposure, amoxicillin-clavulanic acid appears to be an appropriate empiric antibiotic choice in our population.