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The subcutaneous rupture of the tibialis anterior tendon is a rare and silent lesion which can lead to foot and ankle dysfunction with gait difficulty. The treatment can be either conservative or surgical. Conservative management is reserved for inactive patients and those with a general or local contraindication to surgery, whereas surgical repair includes direct and rotational suture, as well as tendon transfer and auto- or allograft. The choice of surgical treatment is based on multiple factors, including the symptoms, the timespan from injury to treatment, the anatomopathological pattern of the lesion, and the patient's age and level of activity. Large defects present a particular reconstructive challenge, and there is no consensus on the optimal method of treatment. That being said, one of the options is an autograft using the semitendinosus hamstring tendon. We present a case of a 69-year-old woman who sustained a hyperflexion trauma to her left ankle. Three months later, ultrasound examination and a magnetic resonance imaging showed a complete tibialis anterior rupture with a gap of more than 10 cm. The patient was successfully treated with surgical repair. An autograft of the semitendinosus tendon was used to bridge the gap. The tibialis anterior rupture is a rare lesion that must be promptly diagnosed and treated, especially in physically active patients. Large defects pose particular challenges. Surgical management was found to be the treatment of choice. In the case of a lesion with a major gap, semitendinosus grafting can be successfully employed.

Febrile urinary tract infection (UTI) is currently considered the most frequent cause of serious bacterial illness in children in the first 2 years of life. UTI in paediatrics can irreversibly damage the renal parenchyma and lead to chronic renal insufficiency and related problems. To avoid this risk, an early effective antibiotic treatment is essential. Moreover, prompt treatment is mandatory to improve the clinical condition of the patient, prevent bacteraemia, and avoid the risk of bacterial localization in other body sites. However, antibiotic resistance for UTI-related bacterial pathogens continuously increases, making recommendations rapidly outdated and the definition of the best empiric antibiotic therapy more difficult. Variation in pathogen susceptibility to antibiotics is essential for the choice of an effective therapy. Moreover, proper identification of cases at increased risk of difficult-to-treat UTIs can reduce the risk of ineffective therapy. In this review, the problem of emerging antibiotic resistance among pathogens associated with the development of paediatric febrile UTIs and the best potential solutions to ensure the most effective therapy are discussed. Literature analysis showed that the emergence of antibiotic resistance is an unavoidable phenomenon closely correlated with the use of antibiotics themselves. To limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be made. An increased use of antibiotic stewardship can be greatly effective in this regard., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between 1 January 2012, and 30 June 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.