Changing prevalence and antibiotic drug resistance pattern of pathogens seen in community-acquired pediatric urinary tract infections at a tertiary care hospital of North India

Abstract

INTRODUCTION: Timely treatment of urinary tract infection (UTI) with appropriate antibiotic administration is of immense importance in children to reduce the consequences.

AIMS AND OBJECTIVES: The aim and objective of this study was to assess the temporal changes in the microbiological profiles and antimicrobial resistance patterns of uropathogens in pediatric community-acquired UTI.

MATERIAL AND METHODS: This is a retrospective analysis of data collected over a Scattered period of 5 years. The baseline data collected were from January to December 2009, and the second period considered for comparison was from January to December 2014. Urine specimens from children (<17 years) suspected of UTI were cultured by a semi-quantitative method on cysteine lactose electrolyte-deficient medium. Antibiotic sensitivity was put up by Kirby–Bauer disc diffusion method as per the Clinical and Laboratory Standard Institute guidelines.

RESULTS: In the year 2009, 340 of 2104 (16.15%) urine specimens yielded significant colony count, whereas in 2014, it was 407 of 2212 (18.39%) (P = 0.051). Escherichia coli was the predominant pathogen and was significantly more prevalent in girls than in boys (P < 0.0001) during both periods. There was a significant overall increase in resistance to ampicillin (from 40.29% to 58.72%), amoxyclav (from 26.17% to 40.54%), nitrofurantoin (from 28.82% to 39.06%), and norfloxacin (from 30% to 41.42%). However, the maximum increase in the resistance was noted for co-trimoxazole from 35.58% in 2009 to 63.39% in 2014 (P = 0.0000058). The prevalence of extended-spectrum beta-lactamases (ESBLs) has also significantly increased from 21.7% to 33.16% (P = 0.0045).

CONCLUSION: Although E. coli remains the prime pathogen in pediatric UTI, the prevalence of resistance has dramatically increased over the 5-year study period. Our study highlights the emergence of community-acquired ESBL-producing uropathogens in children proclaiming treatment challenges.

Key words

Antimicrobials - children - extended-spectrum beta-lactamase producers - microbiological profile - resistance pattern - urinary tract infection

Publikationsverlauf

Eingereicht: 01. November 2016

Angenommen: 16. April 2017

Artikel online veröffentlicht:
19. Februar 2020

• References

• 1 Mårild S, Jodal U. Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age. Acta Paediatr 1998;87:549-52.
• 2 Patzer L, Seeman T, Luck C, Wühl E, Janda J, Misselwitz J. Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 2003;142:117-22.
• 3 Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 1999;104 (1 Pt 1):79-86.
• 4 Narasimhan KL, Chowdhary SK, Kaur B, Mittal BR, Bhattacharya A. Factors affecting renal scarring in posterior urethral valves. J Pediatr Urol 2006;2:569-74.
• 5 Bean DC, Krahe D, Wareham DW. Antimicrobial resistance in community and nosocomial Escherichia coli urinary tract isolates, London 2005-2006. Ann Clin Microbiol Antimicrob 2008;7:13.
• 6 Biswas D, Gupta P, Prasad R, Singh V, Arya M, Kumar A. Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance. Indian J Med Sci 2006;60:53-8.
• 7 Indian Society of Pediatric Nephrology, Vijayakumar M, Kanitkar M, Nammalwar BR, Bagga A. Revised statement on management of urinary tract infections. Indian Pediatr 2011;48:709-17.
• 8 Gupta V, Yadav A, Joshi RM. Antibiotic resistance pattern in uropathogens. Indian J Med Microbiol 2002;20:96-8.
• 9 Collee G, Duguid P, Fraser G, Marmian P. Mackie and McCartney Practical Medical Microbiology. 14^th ed.. New York: Churchill Livingstone Publishers, Longman; 2003.
• 10 Alper BS, Curry SH. Urinary tract infection in children. Am Fam Physician 2005;72:2483-8.
• 11 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: 17th Informational Supplement, CLSI M100-S17. Vol. 27. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.
• 12 Clinical and Laboratory Standards Institute. 2005 Guidelines by CLSI/NCCLS-CLSI Informational Supplement. Approved Standard M100-S15. Wayne, PA: Clinical and Laboratory Standards Institute; 2000.
• 13 Guidoni EB, Berezin EN, Nigro S, Santiago NA, Benini V, Toporovski J. Antibiotic resistance patterns of pediatric community-acquired urinary infections. Braz J Infect Dis 2008;12:321-3.
• 14 Kanellopoulos TA, Salakos C, Spiliopoulou I, Ellina A, Nikolakopoulou NM, Papanastasiou DA. First urinary tract infection in neonates, infants and young children: A comparative study. Pediatr Nephrol 2006;21:1131-7.
• 15 Prelog M, Schiefecker D, Fille M, Wurzner R, Brunner A, Zimmerhackl LB. Febrile urinary tract infection in children: Ampicillin and trimethoprim insufficient as empirical mono-therapy. Pediatr Nephrol 2008;23:597-602.
• 16 Edlin RS, Shapiro DJ, Hersh AL, Copp HL. Antibiotic resistance patterns of outpatient pediatric urinary tract infections. J Urol 2013;190:222-7.
• 17 Topaloglu R, Er I, Dogan BG, Bilginer Y, Ozaltin F, Besbas N, et al. Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children. Pediatr Nephrol 2010;25:919-25.
• 18 Calbo E, Romaní V, Xercavins M, Gómez L, Vidal CG, Quintana S, et al. Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother 2006;57:780-3.
• 19 Apisarnthanarak A, Kiratisin P, Mundy LM. Predictors of mortality from community-onset bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Infect Control Hosp Epidemiol 2008;29:671-4.