PATTERN OF ANTIBIOTIC RESISTANCE IN URINARY ISOLATES IN CHILDREN: WHAT COULD BE THE EMPIRICAL TREATMENT?

Objective: To assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of urinary tract infection (UTI) in our setup. Material and Methods: A retrospective analysis of bacteria isolated from children with UTI was performed at Hayatabad Medical Complex, Peshawar, from January 2005 through June 2008. This evaluation did not consider whether UTI was complicated or uncomplicated, the first or recurrent infection, or nosocomial or community acquired. The data was based solely on laboratory findings. Results: Mean patient age was 26 months and 67% of study population was females. Out of 519 positive urine samples, Escherichia coli (65.9%) was the leading uropathogen followed by Klebsiella pneumoniae (11.6%), Proteus mirabilus (07.1%) and Staphylococcus aureus (5.8%). Bacteria were frequently resistant to Ampicillin (86%), Trimethoprim-Sulfamethoxazole (99.5%), Gentamicin (81.6%), Cefalexin (60.2%) and Cefuroxime (52.5%) but had a resistance of less than 20% against Amikacin, Cefpirome, Ciprofloxacin, Sulzone, Meropenem and Tazocin. Uropathogens isolated below the age of one year are highly sensitive to amikacin, sulzone (p<0.05). No significant difference was noted between the children age less than and more than one year to cefixime, ceftazidime, ciprofloxacin, meropenem and tazocin. Conclusion: Escherichia coli and Klebsiella pneumoniae are the commonest uropathogens causing UTI in children. Cefixime and ciprofloxacin could be the useful empirical oral treatment in children with afebrile UTI below and above one year of age respectively. Whilst amikacin (with/without ceftazidime/IV ciprofloxacin) might be the best empirical antibiotics for all age groups with febrile UTI.