Abstract
Introduction: Prompt diagnosis and initiation of treatment are essential in preventing long-term renal scarring. However, increasing antibiotic resistance may delay the initiation of appropriate therapy. Methodology: A retrospective chart review was performed for patients admitted to the pediatric department with urinary tract infection (UTI) diagnosis in a large tertiary care hospital in Al Baha, Saudi Arabia, from May 2017 to April 2018. The study included children of both sexes under the age of 14 years. Results: Out of 118 urinary bacterial samples, Escherichia coli was the main etiologic agent in the community- and hospital-acquired infections. The infection rate was higher in girls (68.64%) than in boys (31.36%). The commonest isolates were Escherichia coli (44.07%), extended-spectrum beta-lactamase-producing Escherichia coli (11.86%), Klebsiella pneumoniae (9.32%), Enterococcus faecalis (7.63%), methicillin-resistant Staphylococcus epidermidis (4.24%), and coagulase-negative Staphylococci (3.39%). The current study demonstrates that nitrofurantoin (19%) was the most commonly prescribed medication in the inpatient and outpatient departments, followed by trimethoprim/sulfamethoxazole (16%), amoxicillin/clavulanic acid (15%), cefuroxime (10%), azithromycin (8%), ceftriaxone (7%), and ciprofloxacin (4%), while amikacin, amoxicillin, ampicillin, cefepime, imipenem, phenoxymethylpenicillin were prescribed less commonly due to the high resistance rate. Conclusion: The microbial culture and sensitivity of the isolates from urine samples should be routine before starting antimicrobial therapy. Current knowledge of the antibiotic susceptibility patterns of uropathogens in specific geographical locations is essential for choosing an appropriate empirical antimicrobial treatment rather than reliance on recommended guidelines.
Highlights
Prompt diagnosis and initiation of treatment are essential in preventing long-term renal scarring
The current study revealed that nitrofurantoin was the most prescribed medication in inpatient and outpatient departments (19%), and that it is highly sensitive against studied uropathogenic E. coli, ESBL-positive E. coli, K. pneumoniae, and E. faecalis; followed by trimethoprim/sulfamethoxazole (16%) against urinary tract infection (UTI) caused by E. coli, ESBL-positive E. coli, and E. faecalis; amoxicillin/clavulanic acid (15%) against E. coli, ESBL-positive E. coli, and K. pneumoniae; cefuroxime (10%) against E. coli; azithromycin (8%) against E.coli; ceftriaxone (7%) against E. coli and K. pneumoniae; and ciprofloxacin (4%) against E. coli, ESBL-positive E. coli, K. pneumoniae, and E. faecalis
There is strong evidence of antibiotic resistance from our previous study conducted on adult populations in the same geographic area and at the same hospital [20]
Summary
Prompt diagnosis and initiation of treatment are essential in preventing long-term renal scarring. Increasing antibiotic resistance may delay the initiation of appropriate therapy. Urinary urgency and frequency, burning sensation during urination, lower abdominal discomfort, and turbid urine are the common symptoms of UTI. It is divided into lower (cystitis) and upper (pyelonephritis) UTI. UTI is common in children and is one of the leading causes of hospital admission in the pediatric population. The diagnosis of UTI is complex in infants and young children, as urinary symptoms are very nonspecific. The delay in the diagnosis and treatment can lead to renal scarring, hypertension, and renal insufficiency, which may be the primary cause of increased morbidity rates in children
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