Abstract
Objective: Increased antibiotic resistance is a significant problem associated with higher morbidity, mortality, and costs in managing urinary tract infections (UTI). This study aims to analyze the antimicrobial resistance profile of uropathogens isolated from children with the first attack of community-acquired UTI. Material and Methods: This retrospective cohort study was conducted between January 2010-December 2016, with the patients aged one month to 18 years diagnosed with the first attack of community-acquired UTI at the pediatric outpatient clinic of a tertiary care hospital. Patients’ age, sex, UTI history, clinical findings at admission, urine analysis, urine culture, and antibiogram results were recorded. Results: A total of 1086 patients and 1086 cultures were included in the study. The male/female ratio was 1/5.3. The mean age of the children was 73.7±47.1 (0.4-215.9) months. 16.0% were aged 1-24 months. E. coli was the most common causative agent found to be 85.1% in frequency. The overall antimicrobial resistance was found to be highest for ampicillin, followed by piperacillin and trimethoprim-sulfamethoxazole (63.5, 41.6 and 38.1%, respectively). Imipenem, amikacin, and tobramycin had the least resistance (0.5, 0.5, and 7.6%, respectively). The overall antimicrobial resistance against amoxicillin-clavulanate, ampicillin-sulbactam, cefuroxime, ceftriaxone was 19.4, 24, 25.9 and 21.1%; respectively.Extended-spectrum beta-lactamase positivity was detected in 5.6% (n=61) of samples. Conclusion: Our study showed significant increase in antimicrobial resistance to the most common antibiotics which are prescribed before urine culture results and antibiotic sensitivities are available. The resistance rates for amoxicillin-clavulanate, ampicillin-sulbactam, cefuroxime, ceftriaxone was almost 20% or above in children with the first UTI attack in an outpatient setting.
Highlights
Urinary tract infections (UTI) are among the most common bacterial infections in children [1]
Our study showed significant increase in antimicrobial resistance to the most common antibiotics which are prescribed before urine culture results and antibiotic sensitivities are available
Of the 1086 positive urine culture (UC), 16.0% (n=174) were from children aged 1-24 months. 82.4% of UCs were obtained by midstream clean catch. 17.6% were obtained by catheterization
Summary
Urinary tract infections (UTI) are among the most common bacterial infections in children [1]. Following a UTI there is concern with recurrences which can lead to renal scarring associated with long-term complications, hypertension, and renal failure [1-4]. Clinical guidelines about UTI in children encourage rapid diagnosis and early treatment with an appropriate agent to prevent kidney scarring and longterm complications [4-7]. Data are available on the antimicrobial susceptibility patterns of endemic uropathogens in different countries of the world, but it is necessary to update the changing patterns of resistance to determine the appropriate treatment plans [1,2,69]. Since treatment to reduce UTI-related morbidity is usually started early before the results of urinary microbiology are obtained, current data on the most common uropathogens and local antibiotic resistance patterns will help to choose accurate empirical therapy
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