3 Review(s)

Urinary tract infections (UTIs) are counted among the most common infections in children. Most commonly, members of Enterobacteriaceae, particularly urinary pathogenic strains of Escherichia. coli and Enterobacter aerogenes are the primary causative organisms of UTIs in different parts of the world. In spite of the availability and use of the antimicrobial drugs, UTIs caused by bacteria have been showing increasing trends. Antibiotics are a mainstay in the treatment of bacterial infections, though their use is a primary risk factor for the development of antibiotic resistance. Antibiotic resistance is a growing problem in paediatric urology as demonstrated by increased urinary pathogen resistance. The extensive and inappropriate use of antimicrobial agents has invariably resulted in the development of antibiotic resistance which, in recent years, has become a major problem worldwide. Increasing antibiotic resistance among urinary pathogens to commonly prescribed drugs has become a global reality today. Complex paediatric patients with histories of hospitalizations, prior antibiotic exposure, and recurrent UTIs are also at high risk for acquiring UTIs due to extended spectrum beta-lactamase [ESBL] producing organisms. Data regarding the impact of in vitro antibiotic susceptibility testing interpretation on UTI treatment outcomes is lacking. The resistance of bacteria causing urinary tract infection (UTI) to commonly prescribed antibiotics is increasing both in developing as well as in developed countries. Resistance has emerged even to more potent antimicrobial agents. A total of 512 urine samples were collected from our patients of age between 1 to 12 years of both sex of children at Serum Analysis Centre Pvt. Ltd. [Referral Laboratory]; Howrah; West Bengal; India between December 2016 to November 2017. The urine samples were cultured on HiCrome UTI Agra media and Eosin Methylene Blue Agar media [EMB] and the bacterial isolates were identified by gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby Bauer disk diffusion method according to the current National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Among the 512 urine samples examined [1 to 12 year of children], included 276 (54.0%) in Male child & 236 (46.0%) in Female child and 220 (42.9%) of urinary pathogens are isolated. The bacteria were isolates 104 (37.7%) of male child and 116 (49.2%) of female child. In patient of male child, 50% of Each. coli, 34.6% of Klebsiella pneumoniae, 15.4% of others gram negative bacilli and 52.0% Extended- spectrum Beta lactamase [ESBL] stains were isolates. In patient of female child, 72.4% of Each. coli, 20.7% of Klebsiella pneumoniae, 6.9% of others gram negative bacilli and 58.7% Extended- Spectrum Beta lactamase [ESBL] stains were isolates. Resistance rates of Escherichia coli [1 to 12 years of children] isolates were 83.8% to Amoxicillin/clavulanic acid, 70.5% to Cefixime, 23.5% to Fosfomycin, 26.5% to Nitrofurantoin, 63.2% to Ofloxacin, 66.1% to Ceftriaxone, 67.6% to Cefotaxime, 22.0% to Gentamicin, 89.7% to Cefpodoxime, 63.2% to Ciprofloxacin, 19.2% to Tobramycin, 80.8% to Cefprozil, 63.2% to Co-trimoxazole, 92.6% to Cefaclor, 70.5% to Doxycycline, 4.5% to Amikacin, 57.4% to Levofloxacin, 58.9% to Tetracycline and 89.8% to Cefalexin. Resistance rates of Klebsiella pneumoniae [1 to 12 years of children] isolates were 66.7% to Amoxicillin/clavulanic acid, 43.3% to Cefixime, 23.3% to Fosfomycin, 63.3% to Nitrofurantoin, 20.0% to Ofloxacin, 43.3% to Ceftriaxone, 43.3% to Cefotaxime, 13.3% to Gentamicin, 90.0% to Cefpodoxime, 23.3% to Ciprofloxacin, 13.3% to Tobramycin, 76.6% to Cefprozil, 50.0% to Co-trimoxazole, 73.3% to Cefaclor, 33.3% to Doxycycline, 6.6% to Amikacin, 20.0% to Levofloxacin, 36.7% to Tetracycline and 80.0% to Cefalexin. Resistance rates of Others Gram negative Bacilli [1 to 12 years of children] isolates were 75.0% to Amoxicillin/clavulanic acid, 33.4% to Cefixime, 33.4% to Fosfomycin, 41.7% to Nitrofurantoin, 16.7% to Ofloxacin, 66.7% to Ceftriaxone, 16.7% to Cefotaxime, 8.3% to Gentamicin, 91.6% to Cefpodoxime, 25.0% to Ciprofloxacin, 8.3% to Tobramycin, 91.6% to Cefprozil, 41.7% to Co-trimoxazole, 91.6% to Cefaclor, 41.7% to Doxycycline, 8.3% to Amikacin, 8.3% to Levofloxacin, 41.7% to Tetracycline and 91.6% to Cefalexin. The Results of the present study indicate a high incidence of microbial resistance to commonly used oral antibiotics such as Amoxicillin/clavulanic acid, Co-trimoxazole, Cefixime, Cefpodoxime, Cefprozil, Cefalexin in urinary tract infections among children and suggest that physicians should be cautious about treatment with these antibiotics. Knowledge of the local antibiotic resistance patterns will help in guiding antibiotic choice. In our study confirmed Escherichia coli are major urinary pathogen and urinary tract infection was more common among females than male child’s. In summary, a combination of traditional and innovative prevention and treatment strategies is being deployed to combat the threat of emerging antibiotic resistance among urinary pathogens. It is concluded that the clinical isolates have started developing resistance against antibiotics due to its irrational and inappropriate use. The present results in increasing commonly use of oral antibiotic resistance trends in UTI patients in children indicate that it is imperative to rationalize the use of antimicrobials and to use these conservatively. Considering the relatively increase rates of UTI and drug resistance observed in this study, continued local, regional, and national surveillance is warranted. Antibiotics should only be issued when prescribed by physicians. This study will provide novel, clinically important information on the diagnostic features of childhood UTI and the cost effectiveness of a validated prediction rule, to help primary care clinicians improve the efficiency of their diagnostic strategy for UTI in children. Regular monitoring is required to establish reliable information about resistance pattern of urinary pathogens for optimal empirical therapy of patients with UTIs. Finally, we suggest that empirical antibiotic selection should be based on the knowledge of local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal guidelines. Keywords: Urinary tract infections; Antibiotic resistance; Paediatrics; Antibiogram.