Choosing the correct empirical antibiotic for urinary tract infection in pediatric: Surveillance of antimicrobial susceptibility pattern of Escherichia coli by E-Test method
Background and Objectives: Urinary Tract Infections (UTIs) are of the most common bacterial diseases worldwide. We investigate the antibiotic susceptibility patterns of Escherichia coli (E. coli) strains isolated from pediatric patients with community acquired urinary tract infection (UTI) to find a clinical guidance for choosing a right empirical antibiotic in these patients.
Materials and Methods: In this cross sectional study, 100 urine specimens which were positive for E. coli had been investigated for antibiotics susceptibility pattern. The susceptibility to Co-trimoxazol (25µg), Amikacin (30µg), Ceftriaxone (30µg), Nalidixic Acid (30µg), Cefixime (5µg), and Nitrofurantoin (300µg) tested with Disk diffusion agar and MIC determined with the E-test.
Results: Mean age of patients was 38 Months. Girls had greater proportion than boys (74 versus 26%). In Disk diffusion method, 26% of the isolates were susceptible to cotrimoxazole. Susceptibility to amikacin, ceftriaxone, nitrofurantoin, nalidixic acid and cefixime was 94%, 66%, 97%, 62% and 52%, respectively. By E-Test method and according to CLSI criteria susceptibility for co-trimoxazol, amikacin, ceftriaxone and nalidixic acid was 37%, 97%, 67% and 50%, respectively. The highest percentage of agreement between Disk diffusion and E-Test method was found for amikacin (96%) and the lowest percentage for co-trimoxazole (89%).
Conclusions: Treatment failure, prolonged or repeated hospitalization, increased costs of care, and increased mortality are some consequence of bacterial resistance in UTIs. Misuse of antibiotics in each geographic location directly affects antibiotic resistance pattern. In the treatment of UTI, proper selection of antimicrobial agents should be relevant to the bacterial susceptibility testing surveillance. According to our results, amikacin as an injectable drug and nitrofurantoin as an oral agent could be used as a drug of choice in our region for children with UTIs.
Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson text book of pediatrics. 18 Editions. Philadelphia: Saunders; 2007.
Steinke DT, Seaton RA, Phillips G, MacDonald TM, Davey PG. Prior trimethoprim use and trimethoprim- resistant urinary tract infection: a nested case-control study with multivariate analysis for other risk factors. J Antimicrob Chemother 2001;47:781-787.
Dapeng Y. The drug resistance of pathogenic bacteria collected from urinary tract infection patients subjected to the Allied Hospital of Beihua University. China J Misdiagn 2007; 7:2492-2493.
Zhao SB, Song L, Hu H. Distribution of bacteria in urinary tract infection and analysis of drug resistance of these bacteria. Ningxia Med J2007; 29:750-752.
Wang J, Liu H, Xuefeng Z. Drug resistance supervision to pathogens from urinary tract in mountain area of western Hubei province. China J Nosocomial 2007;17:732-733.
Wan X, Wenfang W, Yu C, Changchun C, Yifeng L, Yongxiang x. The pathogenetic characteristics of community-acquired urinary tract infection in female in Nanjing. Jiangsu Med J 2008; 34:571-573.
Wald ER. Cystitis and Pyelonephritis, in Feigin & Cherry’s Textbook of Pediatric Infectious Diseases, WB saunders; 2014: p. 542.
Clinical and Laboratory Standards Institute.Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth informational supplement. Clinical and Laboratory Standards Institute 2014; M100-S24.
Khorvash F, Zarefar S, Mobasherizadeh S, Mostafavizadeh K. Antibiotic Susceptibility Pattern of Organisms Causing Urinary Tract Infection in Spinal Cord Injured Patients with E test. Tabibe Shargh J 2008; 9:305-311.
Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection. Arch Dis Child 2003;88:215-218.
Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Nakhlband A. Causative agents and antimicrobial susceptibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis 2009;13: 140-144.
Vaezzadeh F, sharifi-yazdi MK. Laboratory evaluation of urine culture and drug resistance in children clinically suspected of urinary tract infection (UTI). Iran J Public Health 2001; 30: 123-124.
Erfani Y, Choobineh H, Safdari H, Rasti A, Alizadeh S. comparison of E. test and disk diffusion agar in antibiotic susceptibility of E.coli isolated from patients with urinary tract infection in Shariati hospital (Iran). Journal of Biological Sciences 2008; 3: 24-27.
Haghi-Ashteiani M, Sadeghifard N. Etiology and antibacterial resistance of bacterial Urinary tract infection in children’s medical center ,Tehran. Iran. Acta Medica Iranica 2007;45:153-157.
Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, Marchese A. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents 2009; 34:407-413.
Lixiang Z, Xiang C, Xiaoping Z, Weixia Y, Lanmei D, Xiaojing X et al. prevalance of virulence factors and antimicrobial of uropathogenic E.coli in jiangsu province (China). J Urology 2009; 74:702-707.
Matute AJ, Hak E, Schurink C. Resistancy of uropathogens in symptomatic urinary tract infections in Leon, Nicaragua. Int J Antimicrob agents 2004; 23:506-509.
Dimitrov TS, Udo EE, Emara M, Awni F, Passadilla R. Etiology and antibiotic susceptibility patterns of community-acquired urinary tract infections in a Kuwait Hospital. Med Princ Pract 2004; 13:334 –339.
Hsueh PR, Chen WH, Luh KT. Relationships between antimicrobial use and antimicrobial resistance in Gram-negative bacteria causing nosocomial infections from 1991–2003 at a university hospital in Taiwan. Int J Antimicrobial Agents 2005;26:463–472.
Bergman M, Nyberg ST, Huovinen P, Paakkari P, Hakanen AJ,. Association between antimicrobial consumption and resistance in Escherichia coli. Antimicrob Agents Chemother 2009;53: 912–917.
Pitout JDD, Nordmann P, Laupland KB and Poirel L.Emergence of Enterobacteriaceae producing extended- spectrum b-lactamases (ESBLs) in the community. Journal of Antimicrobial Chemotherapy 2005;56: 52–59.
Colodner R, Rock W, Chazan B, Keller N, Guy N, Sakran W, et al. Risk factors for the development of extended-spectrum b-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis 2004; 23: 163–167.
Moyo SJ, Aboud S, Kasubi M, Lyamuya EF, Maselle SY. Antimicrobial resistance among producers and non-producers of extended spectrum betalactamases in urinary isolates at a tertiary Hospital in Tanzania. BMC Research Notes 2010;3:348-352.
GoldraichNP and Manfroi A. Febrile urinary tract infection: Escherichia coli susceptibility to oral antimicrobials. Pediatr Nephrol 2002;17:173–176.
Wagenlehner FME, Naber KG. Treatment of Bacterial Urinary Tract Infections: Presence and Future. European Urology 2006;49:235–244.
|Issue||Vol 6 No 6 (2014)|
|Antibiotic susceptibility Disk diffusion agar E-Test Escherichia coli Urinary Tract Infections|
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