The Alarming Situation of Hospital Acquired Multi-drug Resistant Urinary Tract Infections in Pediatric Population in Developing World

Abstract

Objectives: The aim of this study was to find the magnitude of multi drug resistant UTI in paediatric urology, showing different uropathogenic bacteria, sensitivity pattern, associated urologic pathologies and surgical procedures. Material and Methods: All Paediatric patients with some urologic procedure in this institute who have multi or extensive or pan drug resistant UTI were included, the record retrospectively collected from hospital record system and analysed with SPSS. Results: We total 54 patients included having mean age of 5.4 years and predominantly male patients. The three most common MDR uropathogens were Pseudomonas aueroginosa (63%), E.coli (18.5%) and Kliebsiella spp (9.3%). Other MDR organisms were Enterococcus, Providencia, Serratia marcescens and Staphylococcus. Overall most sensitive drug was colistin (64.8%), followed by Fosfomycin (18.5%), Carbapenems (16.6%), Aminoglycosides (12.9%), Tigecycline (11.1%), Nitrofurantoin (7.4%), Cephalosporin (5.5%), Vancomycin (5.5%), Linzolid ( 5.5%), Septran (3.7%), while Teicoplanin, Fusidic acid and chloramphenicol all 1.8%. We found two culture reports of Pseudomonas aueroginosa as pan drug resistant. The most common urologic pathologies associated with MDR UTI was urinary stone disease, neurogenic bladder and posterior urethral valves. The prevalent surgical procedures were those, underwent for stone diseases. A substantial increase in hospitalization time noted in these patients. Conclusion: The emergence of multi drug resistance is reaching an alarming level in Paeds urology. Pseudomonas aueroginosa causing UTI replacing E.coli with some pan drug resistant species is worrisome. The wide spread use of broad spectrum antibiotics at primary healthcare level and even without culture reports in the tertiary care level needs revision. This has significant impact on the child morbidity, length of hospital stay and finally financiall loss.