Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia

Abstract

Background Urinary tract infections (UTIs) are common pediatric infections and contribute to high morbidity and mortality. At present, the antimicrobial resistance emergency has quadrupled worldwide and poses a serious threat to the treatment of patients. However, there have been few studies on UTIs in children in Ethiopia, particularly in the east. Objective This study aimed to assess the bacterial profile of urinary tract infections, their susceptibility to antimicrobial agents, and associated factors in under-five children at Hiwot Fana Specialized University Hospital, eastern Ethiopia. Method We conducted hospital-based quantitative study on 332 consecutively selected under-five children from March 20 to June 10, 2021. Parents and guardians were interviewed to collect data using a structured questionnaire. Random urine samples were collected aseptically, and standard microbiological techniques were used to identify the bacteria and test for susceptibility to various antibiotics. Data were entered into Epi Info version 7 and exported to Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Data were analyzed using descriptive analysis, bivariate, and multivariable logistic regression analysis. The crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CI) were used to determine the significance of the predictors. A p-value at a 95% confidence interval of less than 0.05 was considered statistically significant. Results The overall prevalence of bacterial urinary tract infections was 80 (24.1%) 95% CI:19.40–29.00%). Most of the bacterial isolates 55 (68.75%) were gram-negative bacteria, predominantly E. coli 23 (28.75%) and K. pneumoniae 10 (12.50%). Being a rural resident (AOR: 4.10, 95%CI: 1.45 11.54), uncircumcised male (AOR: 3.52, 95%CI: 1.33, 9.39), previous history of antibiotic usage (AOR: 7.32, 95%CI: 2.11, 25.37), indwelling catheterization (AOR: 10.35, 95%CI: 3.74, 28.63), previous history of urinary tract infections (AOR: 5.64, 95% CI: 1.36, 23.38), and urinary frequency (AOR: 5.56, 95%CI: 2.03, 15.25) had higher odds of culture positive result. The majority of the isolates have shown high levels of antibiotic resistance. Meropenem, ciprofloxacin, and amoxicillin-clavulanic acid were effective against gram-negative uropathogens, whereas rifampin and ciprofloxacin were the most sensitive drugs for gram-positive isolates. From the tested bacterial isolates, 53/86 (61.6%), 11/86 (11.6%), and 2/86 (2.3%) were found to have multidrug resistance (MDR), extreme drug resistance (XDR), and pan drug resistance (PDR), respectively. Conclusions About one-fourth of the children were culture-positive for many types of bacterial uropathogens; this is higher compared with most of the previous studies in Africa. Rural dwellers, uncircumcised males, indwelling catheterization, a history of antibiotic use and urinary tract infection, and frequent urination all had a higher risk of bacterial infections. Many isolates were resistant to multiple drugs, primarily beta-lactams. Urinary tract infections as well as the growth and spread of resistant bacterial pathogens should be monitor regularly.

The Antimicrobial Resistance (AMR) Rates of Enterobacterales in a Rural Hospital from the Eastern Region, Ghana: A Retrospective Study, 2022

“…Previous similar studies have also reported a link between bacterial infections in urine and factors such as residing in rural areas, being uncircumcised, and experiencing frequent urination, which could be more prevalent in older age groups. Additionally, the frequency of resistance in urinary tract infections is higher due to patients often receiving prescribed antibiotics and self-administering them without supervision, particularly in regions where self-medication practices are common [ 35 , 36 , 37 ].…”

Prevalence of meropenem-resistant Pseudomonas Aeruginosa in Ethiopia: a systematic review and meta‑analysis

“…Geographically, the studies were distributed across various regions of Ethiopia, with eight conducted in the Amhara region [ 26 – 33 ], three in Oromia [ 34 – 36 ], three in SNNPR [ 37 – 39 ], four in Addis Ababa [ 40 – 43 ], and one in Harari [ 44 ].…”

Bacterial aetiology, antimicrobial susceptibility patterns, and factors associated with urinary tract infection among under-five children at primary health facility, North-Western Tanzania

“…A study conducted in Indonesia reported that circumcision was associated with a decreased incidence of UTI in children [ 32 ]. Additionally, a study conducted in Ethiopia found that uncircumcised male children have a higher risk of acquiring UTI compared to those who are circumcised [ 13 ].…”

“…The commonly reported factors include female gender, poor hygiene, poverty, malnutrition, and recurrent infections [ 11 ]. Other predisposing factors include lower age, uncircumcision in males, genitourinary anomalies, indwelling urinary catheters, and previous antibiotic use [ 12 , 13 ]. Urine culture is rarely performed as part of patient management in rural areas with inadequate diagnostic resources.…”