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 (< 28 days,n = 45), infants (28 days to 2 years, n = 41), and children (> 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 activeagent 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 agentsagainst 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.