A 6-year-old girl with chronic renal failure secondary to bilateral grade 5 vesicoureteral reflux with hydronephrosis and severe malnutrition.
He received prophylaxis for recurrent UTI with cotrimoxazole and had a history of exposure to several antibacterial agents in recent months (cefuroxime, ceftriaxone and ciprofloxacin).
She was admitted to the ICU for acute pyelonephritis and acute chronic renal failure.
The urine culture performed on admission was positive for E.coli ( UTI1 strain) sensitive to ampicillin, cephalothin, cefuroxime, ceftriaxone and gentamicin; resistant to ciprofloxacin and cotrimazol.
She was treated with cefuroxime iv 150 mg/kg/day.
On the sixth day she presented with urinary sepsis.
Treatment was switched to ceftriaxone IV to 100 mg/ kg/day prior to uroculture.
At 48 h the patient remained febrile.
Urocultiva was reported with > 105 CFU/ml of E. coli ( UTI2 strain) sensitive to imipenem, meropenem, amikacin and gentamicin, cephalothin resistant to ampicillin.
Intravenous meropenem 60 mg/kg/day was initiated, with good clinical and urocultive control evolution, intra-treatment, without bacterial development.
1.
Molecular typification and resistance mechanism: Median EFCP confirmed that both strains were genetically indistinguishable.
The UTI2 strain presented a SHV-5 ESBL encoded in a conjugative plasmid of the IncFIB group, absent in the UTI1 strain.
