ETIOLOGY AND ANTIBIOTIC RESISTANCE PATTERN OF COMMUNITY-ACQUIRED URINARY TRACT INFECTIONS IN CHILDREN

ABSTRACT
Objective: To find out the causative agents of community-acquired urinary tract infections and their antibiotic sensitivity
pattern in pediatric patients.
Methods: This study was conducted at Pediatric department, Khyber Girls Medical College/Hayatabad Medical Complex,
Peshawar from 1st July 2014 to 30th June 2015. All children from 2 months to 15 years of age with provisional diagnosis
of UTI based on history and urinalysis findings were included in the study after taking consent. Urine samples for cultures
were obtained by suprapubic aspiration, transurethral bladder catheterization or clean-catch midstream method.
The bacterial agents which caused UTI were isolated, characterized & identified using standard microbiological tests.
Antibiograms of all the isolates were performed by the disc-diffusion technique using Ampicillin, Amoxycillin + Clavulanic
acid, Cephalexin, Cefixime, Ceftriaxone, Cefotaxime, Co-Trimaxazole, Ciprofloxacillin, Nalidixic acid, Nitrofurantoin,
Amikacin, Gentamycin, Cefoperazone/Sulbactam, Piperacillin/Tazobactam and Meropenem.
Results: Out of 230 positive urine cultures, 225 (97.8%) were gram negative bacilli and 5 (2.2%) were gram positive
cocci. Among gram negative bacteria, E.coli was the predominant isolate (165/225) followed by Klebsiella sp (30/225)
and Pseudomonas (13/225). All gram negative bacteria in general were found to be resistant to the commonly used
antibiotics and were sensitive to amikacin, nitrofurantoin, imipenem, cefoperazone/sulbactam and piperacillin/tazobactam.
Moreover, 50.9% of the E-coli were extended spectrum beta lactamase (ESBL) producer.
Conclusion: The resistance pattern of uro-pathogens causing urinary tract infections to common antimicrobial agents
is changing and must be taken into account when selecting treatment strategies.
Such studies will guide clinicians to choose accurate empirical treatment options and will help to reduce the mortality
and morbidity. Moreover, a change in empiric therapy should be considered.
Key Words: Urinary tract infections, E.coli, Klebsiella, Antibiotic sensitivity/resistance pattern, Empirical treatment,