Identifying the characteristics of antibacterial resistance in urine specimens of children in the Gaza Strip: a hospital-based cross-sectional study

Abstract

BackgroundAntimicrobial resistance is a challenging issue especially among children due to immaturity of the immune system. Identifying the extent of resistance is the first step in finding an appropriate way to combat it. This study aimed to assess the antibiotic resistance patterns of different bacterial isolates from children's urine specimens. MethodsThis hospital-based, cross-sectional study was done from Nov 1, 2017, to Dec 31, 2018, and used data from bacterial cultures collected and processed in the departments of medical microbiology governmental hospitals across Gaza Strip. We included all identified urine specimens from inpatient and outpatient clinics of children (ages 1–12 years) irrespective of whether they were admitted to hospital. We excluded children who had missing data or cultures without defined microorganisms or that were contaminated. Identification of bacteria was based on conventional methods (colony morphology, Gram stain, and biochemical tests). Standard disc diffusion drug susceptibility testing was performed after identifying the bacterial isolates. WHO guidelines were followed for data collection and analysis for bacterial antibiotic susceptibility and resistance. Ethics approval for the study was obtained from the Palestinian Ministry of Health. As data were anonymised, consent was not needed for use. FindingsOf 7144 urine specimens collected, 1726 (24·2%) showed positive microorganism growth. The three most abundant bacterial microorganisms were Escherichia coli (1010 [58·5%]), Klebsiella sp (266 [15·4%]), and Pseudomonas sp (93 [5·4%]). Resistance of E coli to antibiotics was as follows: amoxicillin 96·5% (358 of 371 samples tested), amoxicillin/clavulanic acid 88·3% (188 of 213), cefalexin 66·5% (489 of 735), cefuroxime 49·1% (265 of 540), ceftriaxone 39·3% (268 of 682), gentamicin 19·0% (138 of 729), meropenem 7·4% (nine of 122), and amikacin 1·0% (five of 493). For Klebsiella sp, resistance to amoxicillin was 96·0% (96 of 100 samples tested), amoxicillin/clavulanic acid 90·0% (36 of 40), cefalexin 73·8% (141 of 191), ceftriaxone 64·42% (117 of 182), cefuroxime 63·1% (101 of 160), gentamicin 33·3% (64 of 192), and amikacin 0·7% (one of 141). Resistance of Pseudomonas sp to cephalexin was 90·0% (54 of 60 samples tested), cefuroxime 80·8% (42 of 52), ceftriaxone 39·4% (26 of 66), ceftazidime 29·3% (17 of 58), gentamicin 28·0% (19 of 68), and amikacin 3·9% (two of 52). InterpretationAntimicrobial resistance is prevalent among investigated bacteria, especially to first-line and second-line antibiotics. Continued surveillance and a tracking system for multidrug-resistant bacteria are needed. Judicious and rational antibiotic usage is recommended. FundingNone.