Bacterial Pathogens and Resistance Patterns in Children With Community-Acquired Urinary Tract Infection: A Cross Sectional Study

Abstract

Background: Recent studies on bacterial pathogens causing urinary tract infection (UTI) in children have shown high levels of antibiotic resistance in clinical settings. Objectives: We determined the common bacterial pathogens causing UTI and their antimicrobial resistance patterns in Iranian children. Patients and Methods: The study subjects were 114 children (female subjects, 58.8%) with culture-proven UTI categorized in the following 3 age groups: neonates ( 2 years, n = 28). Sensitivity testing was performed using the disc diffusion technique. Results: The most frequently cultured pathogens included Escherichia coli (71.7%) and Enterobacter (28.9%). UTI caused by Enterobacter was more commonly detected in neonates (60.6%) than in infants (21.2%) and children (18.2%). Imipenem was the most active agent against E. coli isolates (susceptibility, 97.3%), followed by ciprofloxacin (90.4%) and amikacin (82.9%). Trimethoprim-sulfamethoxazole, cefalotine, and cephalexin were the least active agents, with 76.3%, 75.0%, and 73.7% of E. coli isolates exhibiting resistance, respectively. Imipenem and ceftizoxime were the most effective antimicrobial agents against Enterobacter, with sensitivity rates of 85.2% and 71.4%, respectively. Nitrofurantoin, ceftazidime, and cefalotine were the least active antimicrobial agents against Enterobacter, with resistance rates of 92.3%, 66.7%, and 62.5%, respectively. Conclusions: The low susceptibility of common UTI pathogens to cephalosporins may be because of their high rate of administration to children with UTI in our population. A change in empiric therapy should be considered, especially in neonates. Implication for health policy/practice/research/medical education: Most of the recent studies, on antimicrobial susceptibility of bacterial pathogens causing UTI in children showed high levels of resistance to antibiotics. The present study determined the common types of bacterial pathogen causing UTI in children and their antimicrobial resistance patterns at a sample of Iranian children. Our results could be useful for pediatrician, children nephrologists, and infection diseases specialists.