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Published on: March 2, 2020
An observational study on multidrug resistance in pediatric patients with urinary tract infections
Garzain Bint E Attar1, Shaista Ahmed1, Neetu Shree2
1Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India.
Insights
Pediatric urinary tract infections (UTIs) are common, with Escherichia coli as the main cause. Rising antimicrobial resistance (AMR) necessitates careful antibiotic selection, as many common drugs are ineffective against pediatric UTIs.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Pediatric urinary tract infections (UTIs) represent a significant cause of morbidity in children.
- Escherichia coli is the predominant pathogen, but increasing antimicrobial resistance (AMR) complicates treatment, especially in resource-limited settings.
- Data on AMR patterns in pediatric UTIs is often scarce, hindering effective management.
Purpose of the Study:
- To investigate the prevalence of uropathogens causing UTIs in children.
- To determine the antimicrobial susceptibility patterns of common uropathogens.
- To assess the extent of multidrug resistance (MDR) in pediatric UTI isolates.
Main Methods:
- A 6-month cross-sectional study involving 80 children (<18 years) with culture-confirmed UTIs.
- Uropathogen identification using standard biochemical and automated methods.
- Antibacterial susceptibility testing via VITEK 2 and disk diffusion (CLSI guidelines); MDR defined as resistance to ≥1 agent in ≥3 classes.
Main Results:
- Gram-negative organisms comprised 81.3% of isolates, with Escherichia coli (58.8%) being the most common, followed by Enterococcus spp. (17.5%) and Klebsiella pneumoniae (10.0%).
- Escherichia coli showed high resistance to nalidixic acid (84.4%), ampicillin (78.1%), and ciprofloxacin (78.1%), but remained susceptible to fosfomycin (90.6%), ertapenem (81.3%), and nitrofurantoin (71.9%).
- Multidrug resistance was prevalent, limiting therapeutic options; Enterococcus spp. showed high resistance to tetracycline and levofloxacin but remained sensitive to linezolid and vancomycin.
Conclusions:
- Escherichia coli is the leading cause of pediatric UTIs, with significant resistance to commonly prescribed antibiotics.
- Fosfomycin, nitrofurantoin, and carbapenems retain efficacy, but judicious use is crucial to prevent accelerated resistance.
- Pediatric-specific AMR surveillance and antimicrobial stewardship programs are vital for preserving treatment efficacy and improving outcomes.
Abstract:
Pediatric urinary tract infections (UTIs) are a common cause of morbidity, with Escherichia coli as the leading pathogen. Rising antimicrobial resistance (AMR) complicates management, particularly in resource-limited settings where data is scarce. A cross-sectional study was conducted over six months among 80 children (< 18 years) with culture-confirmed UTIs at a tertiary care hospital. Uropathogens were identified using standard biochemical and automated methods, and antibacterial susceptibility was assessed by VITEK 2 and disk diffusion per CLSI guidelines. Multidrug resistance (MDR) was defined as resistance to ≥ 1 agent in ≥ 3 antibacterial classes. UTIs were most frequent in early childhood (62.5%), with a higher prevalence in females (58.8%). Gram-negative organisms accounted for 81.3% of isolates. Escherichia coli (58.8%) was the predominant uropathogen, followed by Enterococcus spp. (17.5%) and Klebsiella pneumoniae (10.0%). Escherichia coli demonstrated high resistance to nalidixic acid (84.4%), ampicillin (78.1%), and ciprofloxacin (78.1%), while maintaining high susceptibility to fosfomycin (90.6%), ertapenem (81.3%), gentamicin (71.9%), and nitrofurantoin (71.9%). Enterococcus spp. exhibited high resistance to tetracycline (64.3%), and levofloxacin (63%). but remained sensitive to linezolid (93.27%), vancomycin (85.71%), teicoplanin (78.57%), and tigecycline (71.4%). A substantial proportion of isolates were multidrug-resistant, limiting therapeutic options. Escherichia coli remains the leading cause of Pediatric UTIs, but high resistance to commonly prescribed antibacterials underscores the need for cautious empirical therapy. Fosfomycin, nitrofurantoin, and carbapenems retain efficacy, though over-reliance may accelerate resistance. Regular, pediatric-specific AMR surveillance and antimicrobial stewardship programs are essential to preserve treatment efficacy and improve outcomes in this vulnerable population.
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