Susceptibility pattern of pediatric uropathogens: Insights from Mirpur Azad Jammu Kashmir Pakistan

Authors

  • Ammara Manzoor Mohtramma Benazir Bhutto Shaheed Medical College, Mirpur Azad Jammu Kashmir
  • Toqeer Ahmed Mohtramma Benazir Bhutto Shaheed Medical College, Mirpur Azad Jammu Kashmir
  • Syeda Tahira Batool Divisional Headquarters Hospital, Mirpur Azad Jammu Kashmir
  • Nabia Chaudhry Divisional Headquarters Hospital, Mirpur Azad Jammu Kashmir
  • Fatima Khurshid Shifa International Hospital Limited. Islamabad Pakistan

DOI:

https://doi.org/10.61529/idjp.v33i2.283

Abstract

Background: Antibiotic resistance in pediatric urinary tract infections (UTIs) is a growing concern, necessitating the assessment of antibiotic susceptibility profiles for effective treatment strategies. The study was designed to assess the clinical profile, common uropathogens causing UTI and their antimicrobial susceptibility patterns. The study was designed to assess the frequency of pediatric UTIs along with antimicrobial susceptibility pattern of the isolated uropathogens.

Material and Methods: We conducted a retrospective review of clinical records at DHQ Hospital Mirpur AJK, Pakistan from March to September 2023, focusing on urinary tract infections in pediatric patients. We identified uropathogens and their antimicrobial susceptibility pattern to guide effective treatment strategies and address drug resistance.
Results:
Data was collected from the medical records of 140 pediatric patients. of which, 49% (n=69) had positive urine cultures. Majority of these patients were males (71%). The most predominant organism was Klebsiella pneumoniae (32%) followed by, Staphylococcus aureus (26%), Escherichia coli (22%) and Enterococcus faecalis (11%). Mixed growth of uropathogens was seen in 9% of the cases. Regarding Antimicrobial susceptibility pattern, Amikacin, Vancomycin, Neomycin and Tigecycline were the most susceptible (100%), followed by chloramphenicol (90.9%), Linezolid (83.4%), Rifampicin (82%), Meropenem (77.3%), Nitrofurantoin (70%), Tazobactam (68.7%) and Imipenem (68.4%). Cephalexin (66.7%), Gentamicin (63.6%) and Cefipime (50%) showed moderate susceptibility. Whereas, Sulfamethoxazole (35%), Levofloxacin (31.4%), Cefoxitin (26.3%), Ciprofloxacin (22.2%), Tetracycline (20.5%), Cefuroxime (14.2%), Ceftriaxone (9.52%) and Amoxicillin (9.52%) were the least susceptible.

Conclusion: Our research suggests that it is important to review the use of antibiotics for treating UTIs in pediatric patients due to changes in antibiotic susceptibility and the increase in resistance among bacteria. This emphasizes the significance of antimicrobial stewardship.

Keywords: Urinary tract infections. Antimicrobial susceptibility patterns, Pediatric population

References

Shrestha LB, Baral R, Poudel P, Khanal B,. Clinical, etiological and antimicrobial susceptibility profile of pediatric urinary tract infections in a tertiary care hospital of Nepal. BMC Pediatr. 2019; 19 (1): 36.

DOI: https://doi.org/10.1186/s12887-019-1410-1.

Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: A meta-analysis. Pediatr Infect Dis J. 2008; 27(4): 302-8.

DOI: https://doi.org/10.1097/inf.0b013e31815e4122

Downing H, Thomas-Jones E, Gal M et al. The diagnosis of urinary tract infections in young children (DUTY): protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness. BMC Infect Dis. 2012; 158.

DOI: https://doi.org/10.1186/1471-2334-12-158.

Desai DJ, Gilbert B, McBride CA. Paediatric urinary tract infections: Diagnosis and treatment. Australian Family Physician. 2016; 45(8): 558-564.

Habib S. Highlights for management of a child with a urinary tract infection. Int J Pediatr. 2012; 2012(1): 943653.

DOI: https://doi.org/10.1155%2F2012%2F943653

Akhtar SM, Sattar A, Rizwan W, Cheema NA, Anwar A. Microbes and antibiotic susceptibility patterns of urinary tract infections in toilet-trained Children at a Tertiary Care Hospital of Sialkot, Pakistan. Professional Med J. 2021; 28(01): 22-6.

DOI: https://doi.org/10.29309/TPMJ/2021.28.01.4657

Jamil J, Haroon M, Sultan A, Khan MA, Gul N, Kalsoom, et al. Prevalence, antibiotic sensitivity and phenotypic screening of ESBL/MBL producer E. coli strains isolated from urine; District Swabi, KP, Pakistan. J Pak Med Assoc. 2018; 68 (11): 1704-7.

Saeed CH, AL-Otraqchi KIB, Mansoor IY. Prevalence of urinary tract infections and antibiotics susceptibility pattern among infants and young children in Erbil City. Zanco J Med Sci. 2015; 19(1): 915-22.

DOI: https://doi.org/10.15218/zjms.2015.0012

Joan LR, Finlay JC, Lang ME, Bortolussi, Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Community Paediatrics Committee. Urinary tract infections in infants and children: Diagnosis and management. Paediatr Child Health. 2014 (196): 315-25. DOI: https://doi.org/10.1093%2Fpch%2F19.6.315

Le Saux, Nicole. Antimicrobial stewardship in daily practice: Managing an important resource. Paediatr Child Health. 2014; 19 (5): 261-70.

DOI: https://doi.org/10.1093/pch/19.5.261

Bidell MR, Opraseuth MP, Yoon M, Mohr J, Lodise TP. Effect of prior receipt of antibiotics on the pathogen distribution and antibiotic resistance profile of key Gram-negative pathogens among patients with hospital-onset urinary tract infections. BMC Infect Dis. 2017; 17 (1): 176. DOI: https://doi.org/10.1186/s12879-017-2270-7

Mohammad M, Ebrahim-Saraie HS, Mansuri D, Kashei R, Hashemizadeh Z, Rajabi A, et al. Antimicrobial susceptibility pattern and age dependent etiology of urinary tract infections in Nemazee Hospital, Shiraz, South-West of Iran. Int J Enteric Pathog. 2015; 3(3): e26931. DOI: http://dx.doi.org/10.17795/ijep26931

Woo B, Jung Y, Kim HS. Antibiotic sensitivity patterns in children with urinary tract infection: Retrospective study over 8 years in a single center. Child Kidney Dis. 2019; 23(1): 22-8.

DOI: https://doi.org/10.3339/jkspn.2019.23.1.22

Meletis, Georgios. Carbapenem resistance: Overview of the problem and future perspectives. Ther Adv Infect Dis. 2016; 3 (1): 15-21.

DOI: https://doi.org/10.1177/2049936115621709

Cho S, Choi S, Park SE, Lee D, Choi J, Yoo J. Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli. Korean J Intern Med. 2016; 31(1): 156-61.

DOI: https://doi.org/10.3904/kjim.2016.31.1.156

Thy M, Timsit J, Montmollin E. Aminoglycosides for the treatment of severe infection due to resistant gram-negative pathogens. Antibiotics (Basel). 2023; 12 (5); 860. DOI: https://doi.org/10.3390/antibiotics12050860

Mahony M, McMullan B, Brown J, Kennedy SE. Multidrug-resistant organisms in urinary tract infections in children. Pediatr Nephrol. 2020; 35(9): 1563-73.

DOI: https://doi.org/10.3390/antibiotics12050860

Cunha BA. Oral doxycycline for non-systemic urinary tract infections (UTIs) due to P. aeruginosa and other Gram negative uropathogens. Eur J Clin Microbiol Infect Dis. 2012; 31: 2865-8.

DOI: https://doi.org/10.1007/s10096-012-1680-0

Flores-Mireles, AL, Walker JN, Caparon M, Hultgren SJ, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015; 13 (5): 269-84.

DOI: https://doi.org/10.1038%2Fnrmicro3432

Patel S, Preuss CV, Bernice F. Vancomycin. Nih.gov. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459263/

Wingler MJ, Patel NR, King ST, Wagner JL, Barber KE, Stover KR, et al. Linezolid for the treatment of urinary tract infections caused by Vancomycin-Resistant Enterococci. Pharmacy (Basel). 2021; 9 (4): 175.

DOI: https://doi.org/10.3390%2Fpharmacy9040175

Pontefract BA, Rovelsky SA, Madaras-Kelly KP. Linezolid to treat urinary tract infections caused by vancomycin-resistant Enterococcus. SAGE Open Med. 2020; 8: 2050312120970743.

DOI: https://doi.org/10.1177%2F2050312120970743

Squadrito FJ, Del Portal D. Nitrofurantoin [Internet]. Nih.gov. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470526/

Hilt EE, Parnell L, Wang D, Stapleton AE, Lukacz ES. Microbial Threshold Guidelines for UTI Diagnosis: A Scoping Systematic Review. Pathol Lab Medicine Int. 2023; 15: 43–63.

DOI: https://doi.org/10.2147/plmi.s409488

Zeng Z, Zhan J, Zhang K, Chen H, Cheng S. Global, regional, and national burden of urinary tract infections from 1990 to 2019: An analysis of the global burden of disease study 2019. World J Urol. 2022; 40(1):

DOI: https://doi.org/10.1007/s00345-021-03913-0

Liang D, Wang ME, Dahlen A, Liao Y, Saunders AC, Coon ER, Schroeder AR. Incidence of pediatric urinary tract infections before and during the COVID-19 Pandemic. JAMA Network Open. 2024; 7(1): e2350061–e2350061.

DOI:https://doi.org/10.1001/jamanetworkopen.2023.50061

M100 Performance Standards for Antimicrobial Susceptibility Testing A CLSI supplement for global application. 30th Edition [Internet]. Available from: https://nih.org.pk/wp-content/uploads/2021/02/CLSI-2020.pdf

Downloads

Published

01-07-2024

How to Cite

Manzoor, A., Ahmed, T., Batool, S. T., Chaudhry, N., & Khurshid, F. (2024). Susceptibility pattern of pediatric uropathogens: Insights from Mirpur Azad Jammu Kashmir Pakistan. Infectious Diseases Journal of Pakistan, 33(2), 92–96. https://doi.org/10.61529/idjp.v33i2.283