Microbiological Spectrum and Susceptibility Pattern of Clinical Isolates from Children Suspected of Urinary Tract Infection, Visiting Kanti Children's Hospital, Maharajgung, Kathmandu

Abstract

Background: The present study analyzes the clinical profile, identifies the pathogenic distribution and their antimicrobial susceptibility pattern in childhood urinary tract infections in order to provide standard reference for the optimal use of antibiotics in Nepal. Methods: A hospital based cross section study was conducted among children suspected of urinary tract infection in Kanti Children's Hospital over a period of six months from August 2012 to November 2012. A total of 1890both sexes, ranging from post natal period to 14 years of age were studied. The modes of presentation, laboratory investigation reports, which included urine routine microscopy, bacterial isolation with colony count from urine culture, antibiotic sensitivity pattern and multidrug resistant profile, were documented. Data were analyzed by the Chi Square Test. Results: Among 1890 urine samples, 300(15.88%) showed culture positive result: 256 gram negative organisms and 44 gram positive organisms. Among the positive growth samples 144(48%) were male patients and 156(52%) were female patients.; Escherichia coli was most common organisms isolated (52.33%), followed by Klebsiella spp (17.33%), Staphylococcus aureus(14%), Pseudomonas aeruginosa (4.33%), Proteus spp (3.67%), Citrobacter spp (3%), Acinetobacter spp(1.66%), Enterobacter spp and Hafnia alvei (1.33%), Streptococcus spp (0.66%) and Salmonella paratyphi B(0.33%). Nitrofurantoin was found to have the highest sensitivity (71.67%) amongst most bacteria. Amikacin, Norfloxacin and Gentamicin had sensitivity of 69%, 61.71% and 61.67% respectively. Pseudomonas aeruginosa was 100% sensitive to Tobramycin, Piperacillin and Imipenem. Though sensitivity to Vancomycin was tested to 44 cases it was 100% sensitive to Staphylococcus aureus and Streptococcus fecalis. Highest degree of resistance was noted with Ceftazidime (64%), Ofloxacin (61.33%), Ampicillin (60%), ciprofloxacin (55.67%), Cotrimoxazole (52%), Gentamicin (38.33%), Amikacin (28%) and Nitrofurantoin (23.67%). Conclusion: Infected urine stimulates an immunological and inflammatory response leading to urinary tract injury and scarring, ultimately leading to end stage UTI. In a subtropical country like ours, there is a temporal relationship in the antibiotic sensitivity pattern of UTI. Hence, frequent large-scale studies are required from time to time to note the change in 1 1 the sensitivity and resistance. Complicated UTI and subsequent renal failure continues to be one of the major causes of mortality in children. From this study, it can be concluded that E.coli still remains the commonest isolate in UTI. Nitrofurantoin, Amikacin, Norfloxacin, Gentamicin can be considered effective drugs. An emerging resistance has been noticed with Ceftazidime, Ofloxacin and Amikacin. Vancomycin may be reserve drug of choice in failed or multidrug resistance cases for gram-positive bacteria. Large- scale multicenter studies are required to generalize the data for the whole country.