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Etiology and Antibiotic Susceptibility Patterns of Urinary Tract Infections in Children in a General Hospital in
Khalifa Al Benwan1,2, Wafaa Jamal2,3
1Department of Microbiology, Al-Amiri Hospital, Kuwait, Kuwait.
Insights
Pediatric urinary tract infections (UTIs) in Kuwait show high rates of antibiotic resistance, particularly from E. coli. Extended-spectrum β-lactamase (ESBL)-producing bacteria are prevalent, necessitating local antibiograms for effective empirical treatment.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pediatric Infectious Diseases
Background:
- Urinary tract infections (UTIs) are common in children, posing challenges due to evolving antimicrobial resistance patterns.
- Extended-spectrum β-lactamases (ESBLs) are a significant concern, contributing to treatment failures in pediatric UTIs.
- Understanding local resistance trends is crucial for effective management of pediatric UTIs.
Purpose of the Study:
- To determine the bacterial profile of uropathogens causing UTIs in children.
- To assess the prevalence of antibiotic resistance patterns among these uropathogens.
- To evaluate the extent of extended-spectrum β-lactamase (ESBL)-producing isolates in pediatric UTIs.
Main Methods:
- Analysis of 9,742 urine samples from symptomatic pediatric patients over a 5-year period (2017-2021).
- Bacterial identification using conventional methods and the VITEK 2 system.
- Antimicrobial susceptibility testing via disk diffusion and automated VITEK 2 system; ESBL detection using double-disk diffusion and VITEK 2.
Main Results:
- Significant bacteriuria detected in 13.7% of samples; Escherichia coli was the most common uropathogen (67.3%).
- High resistance rates observed for Enterobacterales against common antibiotics like ampicillin and trimethoprim-sulfamethoxazole.
- Prevalence of ESBL-producing E. coli and Klebsiella pneumoniae was 26% and 55%, respectively.
Conclusions:
- E. coli remains the predominant uropathogen in pediatric UTIs.
- A significant proportion of uropathogens exhibit high resistance to first- and second-line UTI antibiotics.
- High prevalence of ESBL-producing bacteria underscores the need for updated local antibiograms to guide empirical UTI therapy in children.
Objective:
The aim of this study was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as to evaluate the problem with extended-spectrum β-lactamases (ESBLs)-producing isolates, causing urinary tract infections (UTIs) in children in Al-Amiri Hospital, Kuwait, over a 5-year period.
Materials And Methods:
Significant isolates from symptomatic pediatric patients with UTIs from January 2017 to December 2021 were identified by conventional methods and by the VITEK 2 identification card system. Antimicrobial susceptibility testing was performed by the disk diffusion method for Gram-positive organisms and an automated VITEK 2 system for Gram-negative organisms. ESBL-producing Enterobacterales were detected by the double-disk diffusion method and VITEK 2 system.
Results:
Significant bacteriuria was detected in 13.7% of the 9,742 urine samples. Escherichia coli accounted for 67.3% of these, followed by Klebsiella pneumoniae (8.9%), Proteus spp. (5.7%), and Enterococcus spp. (7.4%), respectively. High resistance rates were observed among the Enterobacterales against ampicillin, cephalothin, nitrofurantoin, amoxicillin/clavulanic acid, and trimethoprim-sulfamethoxazole. The prevalence of ESBL-producing E. coli and K. pneumoniae was 26% and 55%, respectively. The most sensitive among the antibiotics tested for Gram-negative organisms were meropenem, amikacin, gentamicin, and piperacillin/tazobactam, while the antibiotics tested for Gram-positive organisms were vancomycin, ampicillin, linezolid, and nitrofurantoin.
Conclusion:
E. coli remains the most common uropathogen. A high percentage of uropathogens causing UTI in children were highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria were highly prevalent in children in our hospital. Local antibiograms should be used to assist with empirical UTI treatment.
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