The Evolving Antibiotic Profile of Paediatric Urinary Tract Infections at a Tertiary Hospital in Cape Town

Abstract

Abstract Background: Urinary tract infection (UTI) is a common problem in infants presenting to hospitals with fever. International data reports that uropathogens and their associated antibiotic susceptibility is evolving. This study describes the organism profile and the respective antibiotic resistance patterns in a paediatric unit at a tertiary hospital in the Western Cape, South Africa. Methods: A retrospective study on urine samples sent to the National Health Laboratory Service from 1 January 2012 to 31 December 2013 was performed. UTI was defined as a single organism growth >105 cfu/ml and leukocytes >1000 cells/ml. The organisms and antibiotic sensitivities were described and stratified into either community, hospital-associated or hospital-acquired infections. Results: Two hundred and eighty-two samples met the study definitions for inclusion in the study. Escherichia coli was cultured most frequently (50.7%) followed by Klebsiella pneumoniae (22.7%) and Proteus mirabilis (4.6%). Extended-spectrum beta-lactamase (ESBL) producing organisms accounted for 26.6% of identified UTI; K. pneumoniae accounted for 54/75 (72%) of those infections. Of ESBL-producing organisms, 6.7% of E. coli were sensitive to piperacillin–tazobactam and 33.3% to amikacin. K. pneumoniae displayed 18.5% and 68.5% sensitivity to piperacillin–tazobactam and amikacin, respectively. E. coli isolates were highly resistant to amoxicillin/ampicillin (90.8%). K. pneumoniae demonstrated high rates of resistance to co-amoxiclavulanate acid (88.7%) and cefotaxime/ceftriaxone (98.2%). Conclusion: The organism population and antibiotic sensitivity profile is evolving in-line with published data. These antibiograms support current hospital policy to treat hospital-associated and acquired infections with piperacillin–tazobactam and amikacin empirically thereby limiting carbapenem drug pressure. Predictors for uropathogen antibiotic resistance require further investigation.