Antibiotic Resistance in Community Acquired Urinary Tract Infection in Children: Data from a Tertiary Center in Eastern India

Introduction: Antibiotic resistance is an increasing global problem which hampers appropriate treatment of Urinary Tract Infection (UTI) in paediatric population, rendering the developing kidneys vulnerable for scarring and long-term complications. The present study stressed upon the most severely affected patients who required hospitalisation for treatment of UTI. Authors conducted this study observing the higher degree of drug resistance in patients admitted to general paediatric ward lately, suffering from UTI. Aim: To observe different clinical presentations of paediatric patients hospitalised with UTI. Authors also intended to identify locally prevalent community acquired bacterial uropathogens of clinical importance and note the sensitivity and resistance patterns of the isolated organisms against different antibiotics. Materials and Methods: This prospective observational pilot study was conducted at the Institute of Child Health, Kolkata, a tertiary care paediatric referral hospital. A total of 950 urine samples (single sample per patient) were collected from hospitalised children (from neonatal age group, upto 12 years) with suspected UTI/sepsis, between October 2014 to April 2016. Of 132 culture positive samples, 35 were excluded as per exclusion criteria, and 97 isolates had antimicrobial sensitivity performed on them. Clinical presentation was documented. Statistical analysis was done using the Chi-Square test. Results: The most common clinical presentations were fever, pain abdomen and anorexia. The most common isolates were Escherichia coli 59/97 (60.82%), followed by Enterococcus spp. 19/97 (19.59%) and Klebsiella pneumoniae 9/97 (9.28%). The majority of E. coli (n=59) isolates showed resistance against all Cephalosporins: 49-52 (83.1-88.1%), meropenem: 39 (66.1%), cotrimoxazole: 42 (71.1%), amoxycillin-clavulanic acid: 55 (93.2%) and quinolones: 50-51 (84.8-86.4%). Most Enterococcus spp. (n=19) isolates were resistant to amikacin: 17 (89.5%). Overall, a large proportion, 79/97 (81.4%) of uropathogens isolated showed Multidrug-Resistance (MDR). Conclusion: The alarming rates of resistance of uropathogens to commonly used antibiotics calls for review of empiric treatment guidelines and emphasises the need for preventing antibiotic misuse in day-to-day practice.