A retrospective study on the microbial spectrum and antibiogram of uropathogens in children in a secondary care hospital in Rural Vellore, South India

Abstract

Background: Urinary tract infection (UTI) is common among children. Empiric antibiotics have to be started as early as possible or it may lead to an irreversible renal parenchymal damage and renal scarring in children. The objectives were to determine the prevalence and microbial profile of paediatric UTI and to determine the antimicrobial susceptibility pattern. Methodology: This is a retrospective study which looked at urine cultures of children below 15 years that were sent during the study period. Results: Among the total urine cultures sent only 21.2% showed significant growth of organisms. The most common organism isolated was E. coli (75.5%). E. coli was least sensitive to cefpodoxime and co-trimoxazole, whereas highly sensitive to nitrofurantoin. Of the total children who had significant growth, 46% had ESBL. Discussion: The prevalence of culture-proven UTI among children was found to be 21.2%. The most common organism isolated among the study population was E. coli (75.5%) followed by Enterococcus species (19.0%) and Klebsiella species (14.5%). It was also found that E. coli was least sensitive to cefpodoxime (31.6%) and co-trimoxazole (26.3%), moderately to amoxicillin-clavulanate (52.4%), whereas highly sensitive to nitrofurantoin (82.9%). This was similar with the studies done at other secondary care hospitals, in Oman and Oddanchathram, South India. Conclusions: With the increasing resistance, cephalosporins should not be used in treating paediatric UTI, whereas nitrofurantoin can be started as an empiric antibiotic, which can later be changed according to the susceptibility pattern.

Retrospective Analysis of Urinary Tract Infection in the Pediatric Population at a Tertiary Care Centre

“…Furthermore, our finding is in accordance with that of other studies as we isolated 83.4% of gram-negative bacteria as pathogens. E. coli was the most common isolate responsible for 54.4% of infectious cases, and this finding is in accordance with that of several studies [ 1 - 3 , 10 , 14 ]. Enterococcus faecium was the second most common isolate in our study.…”

“…In 76% of cases, pyuria was observed (p < 0.0001), and this result is in contrast to that of the study by Tryphena et al that revealed that pyuria was only observed in 22.5% of cases [ 1 ]. This microscopic finding may act as a guiding tool to start empirical therapy based on the local antibiogram, which needs to be changed after obtaining the urine culture and antimicrobial susceptibility report of patients.…”

“…This study found that the prevalence rate of UTI in the pediatric population was 23.5%. Different studies have reported prevalence rates as low as 7.8% in Iran [ 8 ] and 9% in the USA [ 9 ] and as high as 16% in Nepal [ 10 ], 26.45% in Ethiopia [ 2 ], and 21.2% and 26.7% in India [ 1 , 11 ]. Thus, the prevalence in our study was correlated with that of developing countries.…”

“…Enterococcus faecium was the second most common isolate in our study. Tryphena et al and Shrestha et al also isolated Enterococcus spp, and it was considered the second most common isolate [ 1 , 10 ].…”

“…In turn, these can cause hypertension and renal failure. The risks of UTI in childhood are approximately 1%-3% in boys and 3%-10% in girls [ 1 ]. Boys are more affected in the first few months of life than girls (2.7% vs 0.7%) [ 2 ].…”