Clinical profile, bacterial isolates and antibiotic susceptibility patterns in urinary tract infection in children - Hospital based study

Abstract

Background: The present study analyzes the clinical profile and identifies the pathogenic distribution and their antimicrobial susceptibility pattern in childhood urinary tract infections in order to provide standard reference for optimal use of antibiotics.in Nepal. Materials and Methods: Prospective study conducted in the paediatric unit, Manipal College of Medical Sciences and Teaching Hospital, Pokhara over a period of 18 months. A total of 168 patients of both sexes, ranging from post neonatal period to fifteen years of age were studied. The modes of presentation, laboratory investigation reports which included urine routine microscopy, bacterial isolates with colony count from the urine culture and antibiotic sensitivity pattern were documented. Result: Urinary tract infection was common among females (67.2%) with female to male ratio 2:1. Urine culture was positive in 57% of cases. Escherichia coli was the most common organism isolated (50%), followed by Klebsiella (16.66%), Proteus (12.50%), Enterococcus (6.25%). Among the Aminoglycosides, Amikacin was found to have the highest sensitivity (96%) amongst most bacteria. Netilimycin and Gentamycin had sensitivity of 70.8% and 64.86% respectively. Favourable sensitivity was seen with Nitrofurantoin (88.88%), Norfloxacin (78.3%), Ciprofloxacin(80.9%). Though sensitivity to Vancomycin was tested only in 14 cases it was found that Vancomycin was 100% sensitive to Staphylococcus, Enterococcus, E. coli and Klebsiella. Highest degree of resistance was noticed with Amoxicillin (92%), Ampicillin (85.36%), Ceftazidime (85.71%), Amoxyclav (83.33%) and Cefotaxime (76.47%), Cefazolin (62.85%), Ofloxacin(66.66%) and Ceftriaxone (66.66%). Conclusion: Infected urine stimulates an immunological and inflammatory response leading to renal injury and scarring, ultimately leading to end stage renal failure. In a subtropical country like ours, there is a temporal relationship in the antibiotic sensitivity pattern of UTL Hence frequent large scale studies are required from time to time to note the changes in sensitivity and resistance. Complicated UTI and subsequent renal failure still continues to be one of the major causes of mortality in children in this part of Asia. From this study it can be concluded that E. coli still remains as the commonest isolate in UTI. Aminoglycosides and Fluoroquinolones (except Ofloxacin) can be considered as first line drugs. An emerging resistance has been noticed with Cephalosporins. Vancomycin may be a reserve drug of choice in failed or mutidrug resistant cases. Large-scale multicentre studies are required to generalise the data for the whole country.