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 active agent 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 agents against 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.

Bacterial Etiologies and Antibiotic Susceptibility Pattern of Urinary Tract Infections at the Pediatric Ward of Dastgheib Hospital, Shiraz, Iran: A Three-Year Study (2009 - 2011)

“…Similar to reports by Afsharpaiman et al (Najmieh hospital of Tehran, pediatric ward, age group between < 28 days to > 2 years) and Farshad et al (Motahary hospital of Jahrom, age group between one month to 14 years old), E. coli isolates in this study showed a high sensitivity to Imipenem; this confirms the sensitivity of these bacteria to carbapenems (12,19). However, in another study nitrofurantoin and ceftriaxone were the most effective agents against E. coli in Iran (central diagnostic lab of Karaj) (4,5,24).…”

“…Likewise, many scientists reported E. coli as common pathogenic isolates in UTI (12,(19)(20)(21); however, in some geographic regions such as Nigeria (Ebonyi State university teaching hospital, Children's emergency unit, age group between birth to five years old) Klebsiella spp was reported as the main factor of UTI in children (22). In Iran, Monsef and Eghbalian and Mirsoleymani et al reported Klebsiella spp as the second factor for UTI besides E. coli (Ekbatan hospital of the Hamadan University of Medical Sciences, neonatal and neonatal intensive care unit, age group between one to 30 days), as shown in our study (11,16).…”

“…Cephalexin and co-trimoxazole showed a higher resistance pattern to these bacteria. In other studies conducted in different parts of Iran, E. coli showed resistance to co-trimoxazole, ampicillin and cephalexin (5,12,19,24). This could probably be due to the overuse of these antibiotics in the whole country, which has resulted in bacterial resistance.…”

“…Delay in diagnosis and appropriate treatment is the cause of complication in the upper genitourinary system (5). There has been an increase in the rate of antibiotic resistant bacteria associated with UTI in pediatric wards (4,11,12). Also exchange of antibiotic resistance genes among the uropathogenes causes multi-drug resistance to antibiotics (13).…”

Urinary Tract Infection: An Overview of the Infection and the Associated Risk Factors

“…Studies have demonstrated the extent of resistance exhibited the UTI pathogens among children. 116 Antibiotics like trimethoprim-sulfamethoxazole, cefalotine, and cephalexin were not affective against E. coli. In addition, Enterobacter species was highly resistant to antimicrobial agents like Nitrofurantoin, ceftazidime, and cefalotine.…”