Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal

Abstract

BackgroundUrinary tract infection (UTI) is one of most common pediatric infections. The study was designed to assess the clinical profile, common bacterial microorganisms causing UTI and their antimicrobial susceptibility patterns at B. P. Koirala Institute of Health Sciences (BPKIHS) hospital.MethodsThis is a prospective cross-sectional study conducted at Department of Microbiology and Infectious Diseases for 6 months (January to June 2018). A total of 1962 non-repetitive urine specimens (midstream, nappy pad, catheter aspirated) of pediatric patients (0–14 years age) suspected of UTI were obtained in the Microbiology laboratory. Clinical data was obtained from requisition form and hospital software. Culture and bacterial identification was done by using standard microbiological guidelines. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method following clinical and laboratory standards institute (CLSI) guidelines. Resistance to methicillin and vancomycin were confirmed by calculating minimum inhibitory concentration using broth dilution method.ResultsAmong 1962 samples, 314 (16%) were positive for bacterial infection. Fever, irritability and poor feeding was the most common symptoms in neonates while older children presented with fever and urinary symptoms. E. coli was reported the most common etiological agent (53%), followed by Enterococcus faecalis (22%), Klebsiella pneumoniae (7%) and Staphylococcus aureus (7%). Multidrug resistant (MDR) isolates accounted for 32% of isolates, while 5% were extensively drug resistant (XDR). Fourty percentage of gram-negative bacilli were ESBL producer, 38% of S. aureus were methicillin resistant Staphylococcus aureus (MRSA) and 5% E. faecalis were vacomycin resistant enterococci (VRE). E coli was highly resistant to Ampicillin (87%), Ceftriaxone (62%) and Ofloxacin (62%). Amikacin (11% resistance) and Nitrofurantoin (5% resistance) are the most effective drugs for gram-negative bacilli (GNB) while vancomycin and linezolid are functional against gram-positive cocci.ConclusionsHigh-level antimicrobial resistance was observed in pediatric UTI with alarming incidence superbugs like MDR, XDR, ESBL and MRSA. Regular surveillance should be carried out to determine the local prevalence of organisms and antimicrobial susceptibilities in order to guide the proper management of children.

Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal

“…In this study, we found 34.2% of E. coli and 36.7% of K. pneumoniae were MDR. Our findings were similar to those of Shrestha et al who reported that 34% isolates were MDR in Dharan, a city in the eastern part of Nepal, in 2018 [17]. However, few studies in Kathmandu showed a higher proportion (52.3%, 64.9%) of MDR than our study in E. coli [12,18].…”

Prevalence of E. Coli in Urinary Tract Infection of Children Aged 1-15 Years in A Medical College of Eastern Nepal

“…10 Similarly, other studies conducted by Kaur N et al and Rezaee M et al showed predominance of E.coli followed by Klebsiella in their urine culture isolates. 7,8 Antimicrobial sensitivity testing showed E.coli most sensitive to nitrofurantoin (95.5%) followed by ciprofloxacin (91.1%) and amikacin (88.8%) which was similar to the studies conducted by Sharma A et al 6 In contrast to our study, study conducted by Singh SD et al showed highest sensitivity to amikacin. 5 Klebsiella showed highest sensitivity to ciprofloxacin(50.0%) in contrast to study conducted by Sharma et al which showed 100% sensitivity to ciprofloxacin.…”

“…Similar to our study, Singh SD et al and Shrestha LB et al found fever as the most common presenting symptom of UTI in children. 5,7 Abdominal pain, vomiting and dysuria were other common presentations in our study which is shown by other studies as well in association with UTI in children. 8,9 E. coli (53.57%) was the most common etiological agent isolated from urine cultures followed by Klebsiella (14.29%) in our study which is comparable to the study conducted by Kengne M et al which showed incidence of E.coli (59.3%) and Klebsiella (13.0%) respectively.…”

Comparison of Antibiotic Resistance Patterns of Microorganisms Causing Acute Pyelonephritis in Children at 5-year Interval

“…ESBL+ mikroorganizmalar ve dolayısı ile sefalosporin direncinde risk faktörleri; üriner anomaliler, son 3 ayda hastanede yatış öyküsü, nörojen mesane nedeni ile temiz aralıklı kateterizasyon yapılması, ampirik ve profilaktik tedavide geniş spektrumlu antibiyotikleri kullanma, özellikle 1 yaşından önce profilakside sefalosporin kullanmaktır (8,10,11) . Farklı ülke merkezlerinden yakın zamanda yapılan çalışmalarda da ESBL+ mikroorganizma oranı %40-46 arasında bulunmuştur (12,13) . Ülkemizde ESBL+suşlarla ilgili yapılan çalışmalarda, 2001 yılında oran %3,8 olarak bulunmuşken, 2016'da yapılan bir çalışmada bu oran %49,3 olarak saptanmıştır (7,11) .…”