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Pediatric Uropathogens and their Antimicrobial Susceptibility Pattern: Experience from an Impoverished District of
Moiz Ahmed Khan1,2, Nosheen Shakeel1
1Section of Microbiology, Clinical Laboratory, Sindh Institute of Child Health and Neonatology, Karachi, Pakistan.
Insights
This study found a high frequency of pediatric urinary tract infections (UTIs) in Karachi, Pakistan. Enterobacterales, particularly E. coli, were common, with meropenem and imipenem showing the most effectiveness against these uropathogens.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Urinary tract infections (UTIs) are a common pediatric infection, particularly in areas with poor hygiene and sanitation.
- Karachi's Korangi district faces challenges with factors contributing to higher UTI prevalence in its 1.8 million children.
Purpose of the Study:
- To determine the frequency of UTIs in children.
- To identify common uropathogens and their antimicrobial susceptibility patterns.
- To provide data for a pediatric tertiary care center in Karachi.
Main Methods:
- An observational cross-sectional study was conducted from January to August 2023.
- Urine samples from 457 children (1 month to 16 years) were analyzed using standard microbiological techniques.
- Antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method.
Main Results:
- A 19.7% UTI rate was observed, with 90 positive samples.
- Enterobacterales were the predominant uropathogens (95.6%), with Escherichia coli being the most common (73.9%).
- Meropenem and imipenem demonstrated the highest efficacy against isolated uropathogens, while amoxicillin-clavulanate showed low susceptibility.
Conclusions:
- The study highlights a significant burden of pediatric UTIs in Karachi, consistent with national trends.
- Findings offer valuable insights for treating pediatric UTIs in similar settings.
- The results encourage further multi-center research on pediatric UTIs in Pakistan.
Introduction:
Urinary tract infection (UTI) is the most common infection of the pediatric age group. Several factors linked to higher prevalence include poor personal hygiene, improper sanitation, lower socioeconomic status, and malnourishment. In addition to having a worse quality of life, the 1.8 million children who live in Karachi's Korangi district are routinely exposed to such factors.
Objectives:
The study aims to evaluate the frequency of UTI and distribution of uropathogens along with their antimicrobial susceptibility pattern in patients presenting to a pediatric tertiary care center in the Korangi district of Karachi, Pakistan.
Design:
The study employed an observational cross-sectional design.
Methods:
The study was conducted at the Microbiology laboratory of Sindh Institute of Child Health and Neonatology, Karachi, Pakistan from 1st January to 15th August 2023. Urine samples of patients 1 to 16 years of age were collected via midstream clean catch method and of patients from birth up to 1 year were collected in urine collection bags. The samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) agar and antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method.
Results:
A total of 457 urine samples were collected, of which 90 (19.7%) were positive for significant uropathogens. With a mean age of 4.6 years, majority of the culture-positive patients were female (n = 72; 80%). Enterobacterales were the most frequently isolated (n = 88; 95.6%), of which Escherichia coli was the most common (73.9%; n = 68). Citrobacter (n = 7; 7.6%), Klebsiella (n = 6; 6.5%), Serratia (n = 4; 4.3%), Proteus (n = 2; 2.2%), Salmonella (n = 2; 2.2%), and Enterobacter (n = 1; 1.1%) were among the other Enterobacterales isolated. Meropenem and imipenem were the most effective in isolates from Enterobacterales (n = 88) followed by amikacin (n = 84), ciprofloxacin (n = 75), and piperacillin-tazobactam (n = 70). Ceftriaxone and cefixime exhibited moderate susceptibility (n = 69 and 52) whereas, amoxicillin-clavulanate was the least susceptible (n = 3).
Conclusion:
We report high frequency of UTI in our pediatric population with uropathogens and associated antimicrobial susceptibility pattern confirming to the existing trends of pediatric UTIs in Pakistan. In addition to valuable insights for treating patients under similar conditions, our study serves as a catalyst for further multi-center research in this area.
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