TRENDS IN ANTIMICROBIAL RESISTANCE AMONG UROPATHOGENS WITH SPECIAL REFERENCE TO ESCHERICHIA COLI IN COMMUNITY ACQUIRED PEDIATRIC URINARY TRACT INFECTIONS FROM KERALA

CONTEXT: Resistance of uropathogens to commonly used antibiotics is increasingly reported from India in adults. There is little data on resistance patterns in childhood community acquired urinary tract infections (UTI). AIMS: To study antibiotic resistance trends of uropathogens isolated in community acquired UTI in children from a geographic area. SETTINGS AND DESIGN: Prospective study conducted in a northern Kerala tertiary pediatric centre between November 2012 and October 2014. METHODS: Urine samples were obtained by clean catch midstream, bladder catheterization or supra-pubic aspiration. Bacterial growth, when significant were identified by standard biochemical reactions with antibiogram by Kirby Bauers disc diffusion method. STATISTICAL ANALYSIS: Proportions were calculated and statistical significance obtained by Chi-square. RESULTS: Of the 1387 cultures with suspected community acquired UTI, 274 (19.75%) were positive. Mean age of study group was 28.52 months and 64.6% were boys. Escherichia coli (E. coli) was the predominant pathogen [189(69%)] followed by Klebsiella 50(18.2%). Citrobacter, Enterococcus, Proteus and Pseudomonas constituted less than 6%. All urinary isolates showed high combined resistance to most commonly used antimicrobials including beta-lactam antibiotics (84.3% to cefotaxime, 83.2% to cefixime, 74.5% to ampicillin), quinolones (54.2% to ciprofloxacin, 46.4% to norfloxacin, 32.8% to levofloxacin), 52.9% to co-trimoxazole, 30.2% to gentamicin, 24.1% to nitrofurantoin and 14.2% to netilmicin. E. coli was highly resistant tocephalosporins and ampicillin (>80%). CONCLUSIONS: There is increasing resistance amongst E. coli coli and Klebsiella to third generation cephalosporins in pediatric age group. It is important to generate regional data on antibiogram pattern to guide therapy.