Microbial Profile and Antibiotic Sensitivity Pattern in Urinary Tract Infections among Children Attending a Tertiary Care Center, Idukki District, Kerala: A Cross-sectional Study

Abstract

Introduction: Over the recent decades, the importance of Urinary Tract Infections (UTI) has been increasingly recognised in children. The occurrence of UTI during childhood may lead to acute and/or chronic consequences, such as impaired renal function, renal scarring, and hypertension. Due to the irrational use of antimicrobials, multidrug resistant bacterial strains are frequent. Hence, there is an urgent need for continuous surveillance of the microbiological profile of UTI. Aim: To investigate the microbial profile and antibiotic sensitivity pattern from the urine of paediatric patients suspected to have UTI in Idukki district, Kerala and to explore its association with seasonal variations. Materials and Methods: This clinical cross-sectional study was conducted in Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Idukki, Kerala, India, from January 2019 to December 2021. The study involved 882 paediatric patients in the age group 0-15 years with symptoms and signs suggestive of UTI. Data regarding age, gender, season, laboratory and culture results, and antibiotic sensitivity pattern were considered as variables of interest. Analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. The statistical analyses were conducted using Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: The study involved 882 patients, of which 399 were males (45.2%) and 483 were females (54.8%) with a male-tofemale ratio of 0.8:1. The mean age of patients was four years, and a peak incidence was observed in children in the age group of 1-3 years, with 333 (37.8%) children. Microbial growth was observed in the urine of 325 (36.8%) patients. After excluding normal commensal perineal flora and insignificant bacteriuria, 233 samples had significant growth, with males accounting for 106 (45.5%) and females 127 (54.5%). The male-to-female ratio was 0.8 to 1. These samples mostly exhibited growth of aerobic bacteria (232, 99.6%) and Candida albicans (1, 0.4%). E. coli (106, 45.5%) was identified as the most predominant aetiological agent for paediatric UTI. Conclusion: The results of this study suggest that it would be advisable for paediatricians in Idukki district to refrain from using Ampicillin to treat cases suspected to have UTI. Preventive measures should be advised to all patients, with emphasis on urinary hygiene during the monsoon and winter seasons.