Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in children with urinary tract infections in Thi-Qar Governorate
AbstractBackground : There is global emergence of resistance against commonly prescribed antimicrobials . Empirical antibiotics Prescription should be directed by local antimicrobial susceptibility patterns . Objective : To assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of UTI . Methods : A prospective study was conducted in Bint Al-Huda teaching hospital for children ; Thi-Qar – Iraq ; From January 2011 to December 2012 . Urine specimens were obtained from patients younger than 15 years and cultured on appropriate bacteriological medias . Bacterial isolates were Identified by standard tests ; and antibiotic susceptibility was determined by disc diffusion method . Results :From 1000 urine specimens ( 18 % ) had positive results for bacterial cultures . Females out numbered males in all age groups with a ratio of 2.6 : 1 except in the first year of life . E-coli was the most common etiological agent of UTI ( 68.8 % ) followed by proteus spp ( 12.7 % ) ; Klebsiella ( 9.4 % ) ; Enterobacter spp (6.6 %) , citrobacter spp (2.2 %) . High degree of resistance among pathogens to ampicillin (92.2 %); Amoxycillin (81.6 %) ; SXT (81.6 %) ; cephalothin (76.1%) ; 3rd generation cephaloporines (42.2 – 60.5%) . The lowest resistance was to imipenem ( 1.6 % ) ; Amikacin ( 6.1% ) ; nitrofurantoin ( 12.7% ) ; ciprofloxacin ( 15 % ) . Conclusion : Inspite of an increase in the resistance rates of bacterial pathogens causing UTI ; Amikacin is appropriate forintial empirical intra-venous therapy in simple febrile UTI , for complicated febrile UTI imipenem monotherapy is appropriate ; Nitrofurantion could be included as a reasonable alternative in the empirical treatment of lower UTI in older children . The results of this study and numerous observations regarding the increasing resistance to these antibiotics , in several countries ; emphasize the need for local population - specific surveillance for guiding empirical therapy for UTI in children .
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