Bacteriology of urinary tract infection and antimicrobial sensitivities in under-five children in Enugu

Abstract

Background: Urinary tract infection (UTI) is one of the serious bacterial infections in febrile young children, which may cause chronic morbidities. Studies from different parts of Nigeria have shown varying pattern in its bacteriology and antibiotic sensitivities. Antimicrobial resistance rate among uropathogens is an increasing problem limiting therapeutic options, and underscores the need to determine local bacteriological pattern that will guide empiric antibiotic choices. Objectives: To identify the bacterial pathogens responsible for UTI in febrile under-five children in Enugu as well as their antibiotic sensitivity patterns. Methods: A cross-sectional descriptive hospital based study of eligible febrile children aged one to 59 months. Urine samples were collected using mid-stream and suprapubic aspiration methods. Standard laboratory procedures were used to culture the urine specimens, identify the bacterial pathogens as well as their antibiotic sensitivity patterns. Descriptive statistics were used to analyse the outcome. Results: Significant bacteriuria occurred in 22 (11%) of the 200 samples. Escherichia coli isolates were the most common organisms in 7(31.8%) of the 22 positive samples. Others were Staphylococcus aureus, Klebsiella spp and Streptococcus faecalis isolated in 5 (22.7%), 3(13.6%), and 3(13.6%) of the positive samples respectively. Most of the isolates were sensitive to ofloxacin (90.9%), ciprofloxacin (81.8%), nitrofurantoin (77.3%) and ceftriaxone (72.7%). High levels of resistance to ampicillin, cotrimoxazole, amoxicillin, nalidixic acid and clavulanate-potentiated amoxicillin were observed. Conclusion: Escherichia coli is the most common cause of UTI in febrile under-five children studied. Ciprofloxacin and ceftriaxone showed better sensitivities are advocated for the empiric treatment of febrile UTI in Enugu.

Bacteriological Profile of Urinary Tract Infection in Children of a Tertiary Care Hospital

“…28 Third generation Cephalosporins were found to be having better coverage with relatively low reported resistance in different studies and were suggested for the empiric treatment of febrile UTI. 5,10 But in this study, Cephalosporins had higher resistance rates to E. coli and others. This reveals grave therapeutic implications for patient care, as many traditional antibiotics, which are affordable and easily available, are no longer useful.…”

“…Inspite of good sensitivity of uropathogens to Nitrofuratoin, it may not have good compliance in practice due to its bitterness. 5 Nevertheless, some studies recommended Nitrofurantoin as the first choice among oral antibiotics for prophylaxis and treatment of UTI in children due to higher sensitivity. 28 Third generation Cephalosporins were found to be having better coverage with relatively low reported resistance in different studies and were suggested for the empiric treatment of febrile UTI.…”

“…7 A pure growth of ≥10 2 CFU/ml from catheterized urine sample or growth of any number of uropathogen from urine obtained by suprapubic aspiration is considered as significant bacteriuria. 5 Although E. coli has been reported to account for most of the cases of symptomatic UTI in children, 6,7 studies from some other parts of the world however, have shown a changing trend in the bacteriology of UTI. [8][9][10] The spectrum of etiologic agents causing UTI and their antimicrobial resistance pattern have been continuously changing over the years, both in community and in hospitals.…”

“…The selection of antibiotics should be based on the pattern of urinary pathogens and their antimicrobial sensitivities in the local environment. 5 Urine culture & sensitivity is the gold standard for the diagnosis of UTI. 6 On culture, a colony count of more than 10 5 colony forming units /ml organisms of a single species in midstream urine of girls and >10 4 CFU/ml organisms in boys are considered confirmatory of UTI.…”

Bacteriological Profile and Antimicrobial Sensitivity Pattern of Urinary Tract Infection in a Tertiary Care Hospital of Bangladesh

“…2 Third generation cephalosporins were found to be having better coverage with relatively low reported resistance in different studies and were suggested for the empiric treatment of febrile UTI. 13,16 But this study showed increased resistance of E. coli to ceftriaxone and other cephalosporins like cephradin, cefuroxime, cefixime. Most of these antibiotics are used empirically in Bangladesh and resistance of E. coli to these commonly used antibiotics appears to be alarming.…”