Fluoroquinolone Susceptibility Profiles of Recent Urinary Tract Isolates Obtained from Pediatric Patients

G. Noel1, A.T. Evangelista2, Y.Cheung Yee2, D.C. Draghi3, N.P. Brown3, E. Crites3, C. Thornsberry3, D.F. Sahm3, K. Murfitt3, K. Tomfohrde3, and M.E. Jones4
1J&J PRD, Raritan, NJ, USA, 2OrthoOrtho-McNeil, Inc., Raritan, NJ, USA, Eurofins
EurofinsAntiAnti-Infective Services (Focus BioBio-Inova, Inc.), 3Herndon, VA, USA & 4Plaisir, France

Contact Information:
Daniel F. Sahm, Ph.D.
Eurofins
EurofinsAntiAnti-Infective Services
(Focus BioBio-Inova, Inc.)
Herndon, VA, USA
dsahm@focusbioinova.com

Presentation No. 282

METHODS

REVISED ABSTRACT
Background: Although fluoroquinolone (FQ) therapy for urinary tract infections (UTI) is
primarily directed for adult patient populations, this drug class is occasionally used in the
pediatric (PED) population. In addition to monitoring the activity of trimethoprim/
sulfamethoxazole against common UTI pathogens, surveillance (SUR) data are needed to
monitor the ongoing level of FQ activity for these pathogens, and to monitor drug activity
with respect to patient age.
Methods: SUR data (2003-2005) obtained from over 300 sites throughout the USA by The
Surveillance Network (TSN) Program were analyzed to evaluate the level (based on percent
susceptibility [S]) of LV, CP, and TS (trimethoprim/sulfamethoxazole) for UTI isolates of
E. coli (EC; n=651,916 LV, n=697,925 CP, n=792,413 TS isolates), K. pneumoniae (KP;
n=114,307 LV, n=120,621 CP, and n=137,222 TS isolates), and P. mirabilis (PM; n=76,074
LV, n=78,644 CP, and n=90,796 TS isolates). Susceptibilities were analyzed according to
the following PED age (years [y]) groups: <2 y, 2 to 4 y, 5 to 10 y, and 11 to 17 y. For
comparison, data from non-PED groups (18 to 64 and 65 y) were included.

Surveillance data (2003-2005) obtained from over 300 sites throughout the United States of America by
The Surveillance Network (TSN) Program were analyzed to evaluate the level of levofloxacin,
ciprofloxacin, and trimethoprim-sulfamethoxazole for urinary tract infection isolates against E. coli
(n=651,916 levofloxacin, n=697,925 ciprofloxacin, n=792,413 trimethoprim-sulfamethoxazole
isolates), K. pneumoniae (n=114,307 levofloxacin, n=120,621 ciprofloxacin, and n=137,222
trimethoprim-sulfamethoxazole isolates), and P. mirabilis (n=76,074 levofloxacin, n=78,644
ciprofloxacin, and n=90,796 trimethoprim-sulfamethoxazole isolates). Percent susceptibilities were
analyzed according to the following pediatric age groups: <2 years, 2 to 4 years, 5 to 10 years, and 11
to 17 years old. For comparison, data from non-pediatric age groups (18 to 64 and 65 years old) were
included.

<2
97
97.2
74.6
99.6
99.3
88.7
97
96.5
89.2

% S by Patient Age (Years)

2-4
5-10
11-17
18-64
97.8
97.7
97.6
92
97
97.5
97.4
92.4
73.1
76.4
82.5
80.4
99.3
99.3
98.1
93.7
96.8
98.2
97
93.7
79.4
77.7
82.2
88.7
98.1
99
99
87.8
95.7
98.6
98.1
86.3
88.9
90.3
94.6
86.9

Organism
E. coli
65
79.6
80.1
77.3
93.3
93.8
90.5
68.4
64.5
75.6

Conclusions: LV and CP activities against each of the three common uropathogens

isolated from PED UTI were high (> 95% S). However, because S has decreased among
organisms from other patient age groups, ongoing age-related SUR of in vitro activities of
selected agents against common uropathogens is warranted.

BACKGROUND
Fluoroquinolone therapy for urinary tract infections is primarily directed for adult patient
populations. However this drug class is occasionally used in the pediatric population.
Surveillance data used to monitor fluoroquinolone activity against common urinary tract
pathogens isolated from adult and pediatric infections is essential.

Figure 3. Antimicrobial profiles of P. mirabilis by

patient age groups

Table 1. Percent susceptibility of Escherichia coli by patient age groups

Agent
Levofloxacin

% Susceptibility by Patient Age (Years)

<2
2-4
5-10 11-17 18-64 65
97.0
97.8
97.7
97.6
92.0
79.6

Ciprofloxacin

97.2

Results:

Organism Agent
EC
LV
CP
TS
KP
LV
CP
TS
PM
LV
CP
TS

Figure 1. Antimicrobial profiles of E. coli by patient

age groups

Trimethoprim-sulfamethoxazole

74.6

97.0
73.1

97.5
76.4

97.4
82.5

92.4
80.4

80.1
77.3

Figure 2. Antimicrobial profiles of K. pneumoniae by

patient age groups

Table 2. Percent susceptibility of Klebsiella pneumoniae by patient age

groups
Organism
K. pneumoniae

Agent
Levofloxacin

% Susceptibility by Patient Age (Years)

<2
2-4
5-10 11-17 18-64 65
99.6
99.3
99.3
98.1
93.7
93.3

Ciprofloxacin

99.3

96.8

98.2

97.0

93.7

93.8

Trimethoprim-sulfamethoxazole

88.7

79.4

77.7

82.2

88.7

90.5

RESULTS
E. coli:
In all, pediatric patient age groups 10 years old had levofloxacin and
ciprofloxacin susceptibilities >97%. In contrast, the percent susceptibility
for trimethoprim-sulfamethoxazole was <80%.
K. pneumoniae:
Levofloxacin and ciprofloxacin profiles obtained with K. pneumoniae
were similar to those obtained with E. coli for patients 10 years old.
In the <2 year old group, trimethoprim-sulfamethoxazole susceptibility
was 88.7%.
P. mirabilis:
For both levofloxacin and ciprofloxacin the percent susceptibility in the
10 year old group was above 95%. A consistent trend was that the
percent susceptibility for levofloxacin was higher than the percent
susceptibility for ciprofloxacin, regardless of the age group examined.

Table 3. Percent susceptibility of Proteus mirabilis by patient age groups

Organism
P. mirabilis

Agent
Levofloxacin

% Susceptibility by Patient Age (Years)

<2
2-4
5-10 11-17 18-64 65
97.0
98.1
99.0
99.0
87.8
68.4

Ciprofloxacin

96.5

Trimethoprim-sulfamethoxazole

89.2

95.7
88.9

98.6
90.3

98.1
94.6

86.3
86.9

64.5
75.6

CONCLUSION

ACKNOWLEDGEMENTS

For all three uropathogenic species studied, levofloxacin and ciprofloxacin

susceptibility rates remained high (>95%) among isolates from pediatric patients.
However, the potential for age-related resistance to increase suggests that
continued surveillance focused on pediatric populations is warranted.

This study was supported by Ortho-McNeil, Inc., Raritan, NJ and J&J PRD,
Raritan, NJ.

th
44
44th Infectious
Infectious Disease
Disease Society
Society of
of America
America (IDSA)
(IDSA)
Toronto,
Toronto, Ontario,
Ontario, Canada
Canada
October
October 12-15,
12-15, 2006
2006