29 2013 Gram-negative urinary tract infections and increasing isolation of ESBL-producing or ceftazidime-resistant strains in children: results from a single-centre survey Infezioni delle vie urinarie da batteri Gram-negativi e aumento di ceppi ESBL-produttori in pediatria. Risultati di uno studio osservazionale monocentrico Stefano Giardino 1 , Roberto Bandettini 2 , Maddalena Perotti 2 , Giorgio Piaggio 4 , Ludovica Degl’Innocenti 4 , Rosanna Sacco 5 , Antonella Ciucci 5 , Ilaria Caviglia 3 , Paola Barabino 6 , Francesca Ginocchio 3 , Giuseppe Losurdo 3 , Riccardo Haupt 7 , Elio Castagnola 3 1 Stem Cell Transplant Unit, Department of Hematology and Oncology; 2 Laboratory of Microbiology; 3 Infectious Diseases Unit, Department of Pediatrics; 4 Nephrology Unit, Department of Pediatrics; 5 Hospital Infection Control Team; 6 Service of Pharmacy; 7 Epidemiology and Biostatistics Section, Istituto Giannina Gaslini, Genoa, Italy n INTRODUCTION T he emergence of resistant pathogens, espe- cially among Gram-negatives, represents one of the most feared phenomena in re- cent years. Urinary Tract Infections (UTIs) are frequent in children, and Gram-negative bacte- ria are the most frequently isolated cause of such diseases. The high frequency of UTIs in pediatrics is due to the presence of specific risk factors like uri- nary tract malformation and neurogenic blad- der dysfunction, especially in patients affected by spina bifida [1]. Children with these specific risk factors often receive long-term, low-dose antibacterial prophylaxis besides the therapy of specific infectious episodes [1, 2]. The use of wide-spectrum antibiotic prophylaxis and ther- apies in children with UTIs is probably the most important cause for the development of resistance in Gram-negative rods with the emergence of extended-spectrum beta-lacta- mase (ESBL) producing or AmpC beta-lacta- mase cephalosporin-resistant (ceftazidime, CAZ-R) strains [3-5]. In this report we describe the epidemiology of UTIs due to Gram-negative and the occurrence of ESBL and CAZ-R strains observed at the Gaslini Children’s Hospital in Genoa during a prospective survey performed from January 2007 to December 2011. n PATIENTS AND METHODS The Istituto Giannina Gaslini (IGG) is a paedi- atric hospital in northern Italy that acts as a lo- cal paediatric hospital for the town of Genoa and as a tertiary care hospital for other Italian Articolo originale Original article Le Infezioni in Medicina, n. 1, 29-33, 2013 *Corresponding author Elio Castagnola E-mail: eliocastagnola@ospedale-gaslini.ge.it